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250 INFECTIONS OF THE PERI-APICAL TISSUES \

make a linear, or preferably a semicircular incision of the
gum over the apex, cutting to the bone. Hold the tissues
back with a gum retractor, and deflect the periosteum with
a perioseotome. Now remove the overlying bone with chisels,
or the bone may be drilled through with a surgical bur or

drill. After exposing the root end excise it, or cut it off
with a fissure bur, remove the excised portion with an
elevator or excavator, and smooth up the end with a
round bur. Some operators prefer to excise the root with
chisel and mallet, although there is danger of splitting the

root. Next curette the area, removing any necrosed bone
present, flush out with an antiseptic solution, and in extensive
cases, pack with sterile gauze. The packing should be
changed every other day until granulation fills in the opening.
In the majority of instances it is better practice to close the

gum flap and stitch together with silk. In either case, the
patient should keep the mouth clean with an antiseptic wash
and the heahng process should be observed by occasional
subjection to the X-ray.

SOME RECENT METHODS OF TREATING SEPTIC
CONDITIONS IN THE ROOT CANALS AND
PERIAPICAL TISSUES

Silver Nitrate and Formalin. (Percy R. Howe). ,
Recently a combination of the double salt of ammonium

silver and formahn has been advocated by Howe for the
treatment of putrescent pulps and chronic alveolar abscesses.
The author does not believe that this method should be used
as a routine measure in the treatment of cases of this nature,
owing to the marked tendency of the silver salt to produce

discoloration of tooth structure. If forced through the apical
foramen in uncomplicated cases of putrescent pulp, it is also
strongly irritating.