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 or extraoral swellings by incision for drainage is reviewed in Chapters IS and 16.

BOX 17-1 

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 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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