660 THE TEETH. 



With high magnifying powers of the microscope we see that the inflamma- 

 tory process goes on in exactly the same way as in plastic pericementitis. 

 The bundles of connective tissue are transformed directly into inflammatory 

 corpuscles, which at first are all united with each other. This union is recog- 

 nizable in relatively large nests, also, in which there are but scanty capillary 

 blood-vessels left. It is only after the mutual connection of these elements is 

 broken that the bodies, now isolated, deserve the name of pus-corpuscles, 

 which are suspended in an albuminous fluid, and fill a cavity termed an 

 " abscess." If a large number of inflammatory centers, which afterward 

 become confluent all around the root of the tooth, have formed, we designate 

 the disease " alveolar pyorrhrea." 



In some of my specimens, among the inflammatory elements, there are 

 seen capillary blood-vessels, containing a few colorless blood-corpuscles, some 

 of which, by means of a slender pedicle, have penetrated the wall of the cap- 

 illary, and are evidently engaged in emigration. These colorless blood- 

 corpuscles, however, are finely granular, and, as such, easily distinguishable 

 from the surrounding inflammatory corpuscles, the vast majority of Avhich are 

 coarsely granular or homogeneous. Emigrated colorless blood-corpuscles may 

 share in the formation of pus-corpuscles, but the main mass of the latter 

 is doubtless formed directly from the connective-tissue substratum of the 

 inflamed part. 



After the elimination of the pus the surrounding inflamed tissue grows in 

 the shape of so-called " proud flesh" or granulations, which we not infre- 

 quently meet on the roots of teeth extracted during an attack of suppurative 

 pericementitis, especially well developed in the bifurcations between the roots 

 of molars. Such granulations are built up by a myxomatous connective tissue, 

 which is freely vascularized, and, after having filled the cavity of the abscess, 

 is transformed into a dense, fibrous connective tissue. This reparative tissue 

 is termed a " cicatrix." Suppurative pericementitis will invariably heal by 

 cicatrization. 



Alveolar Abscess. This is a peculiar form of suppurative inflammation 

 on the apices of the roots of teeth. 



Examinations of microscopical sections through the root, the socket, and 

 the alveolar abscess, demonstrate that the latter is either unilocular or 

 multilocular, viz. : separated into two or several chambers, all filled with 

 pus. The wall of the abscess is built up by a very dense fibrous connective 

 tissue, the bundles of which mainly run a concentric course around the 

 abscess, and are continuous with the unchanged or slightly inflamed peri- 

 cementuin higher up on the root. The sac is a product of plastic pericementitis, 

 fully identical with what has been termed in former years the " membrana 

 pyogena." When the inflammatory process has lasted for months, the newly 

 formed connective tissue assumes a distinct fibrous structure, and between 

 the bundles there are interspersed nests of inflammatory corpuscles. These 

 may be partly transformed into fat-granules, or produce opaque layers in fatty 

 degeneration. If, on the contrary, the alveolar abscess be of a more recent 

 date, the fibrous, structure of the sac is plainly marked on its periphery only, 

 while the central portions bear the character of a myxomatous granulation- 

 tissue. The strings or the septa traversing the abscess may, in accordance 

 with the age of the disease, be found either of a fibrous or myxomatous 

 structure. In both instances we often meet with a large number of newly 

 formed capillary blood-vessels. The inner surface of the sac is not smooth, 



