Drainage releases. purulent or hemorrhagic transudates and exudates from a focus of liquefaction necrosis (i.e., abscess). Draining the abscess relieves pain, increases circulation, and removes a potent irritant. The abscess may
be confined to bone or may have eroded through bone and periosteum to. invade soft tissue. Managing these i:’.lraoral or extraoral swellings by incision for drainage is reviewed in Chapters IS and 16. An abscess in bone may be drained by two methods: One is by opening into the offending tooth to obtain I .nage through the canal; ‘the abscess often docs not

BOX t1-1
Categories of Endodontic Surgery Abscess drainage Periapical surgery Hemisection/root amputation Intentional replantation Corrective surgery BOX 17-2  Indications for Periapical Surgery Anatomic problems preventing complete debridement/obturation Restorative considerations that compromise treatment Horizontal root fracture with apical necrosis Irretrievable material preventing canal treatment or retreatment  Procedural errors during treatment Large periapical lesions that do not resolve with root canal treatment commurucate with the apex. The- other suggested approach to manage an abscess in bone is called trephination.This is done by attempting to create a pathway with a bur or rotary instrument through gingiva and cortical bone, directly into the abscess. This approach is of questionable effectiveness.!

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