14 



REPULSION OF TEETH. 



the disk of bone removed by the trephine and the detaching 

 of them from the portion of bone to be chiseled away. 



When the tooth has been bared so that every part of its 

 lateral surface can be seen or felt, the punch may be placed 

 against the end of the fang, a few firm, quick blows given 

 with the mallet, so directed that the force is in a line with 

 the long axis of the tooth, and the organ driven into the 

 mouth where it is seized by the forceps or the hand and- 

 removed. If it is not readily and safely dislodged in this 

 way, place the heavy bone chisel against it and with the aid 

 of the mallet comminute the tooth by breaking it trans- 

 versely and splitting it longitudinally, in which process the 

 fragments are generally loosened from the alveolar walls and 

 can then be readily removed wath the aid of the gouge, or 

 heavy dressing or splinter forceps. Remove carefully all 

 fragments of tooth or of loosened bone, cleanse and disinfect 

 the wound, pack with iodoform gauze and dress daily. 



In cases where a fistulous opening remains after repulsion 

 of molars without the removal of the alveolar wall, or if a 

 tooth has been drawn by means of the forceps and the 

 alveolus fails to heal, the bony plate should be removed in 

 the above manner. 



Dangers. Wounding of the adjoining tooth is to be 

 avoided chiefly by carefully locating the fang of the affected 

 one and placing the instrument as exactly as possible over 

 its centre, by using a trephine not exceeding 2 to 2.5 cm. in 

 diameter and cautiously sawing through the compact layer 

 of the external plate only, removing the cancellated tissue 

 with the gouge and extending the opening in the desired 

 ■direction after the outlines of the tooth fang have been 

 clearly determined. If an adjoining fang is wounded, the 

 tooth should be removed as it will not heal but will result 

 in a permanent tooth fistula. 



Fracture of the alveolar walls of the inferior maxilla 

 may occur during the removal of the external alveolar plate 

 -with the chisel or of the repulsion of the tooth with the 



