14 REPULSION OF TEETH. 



transversely and splitting it longitudinally, in which pro- 

 cess the fragments are generally loosened and can then be 

 readily removed with the aid of the gouge or heavy dress- 

 ing 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 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 tooh 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 

 punch and mallet. The first is to be averted by care in 

 having the chisel sharp, by observing the precaution of 

 making a bevelled cut through the bone, by using only 

 moderate blows and driving the instrument alternately for 

 a short distance on each side. The second danger of ex- 

 tensive fracture may be averted by being cautious ta see 

 after each stroke on the punch that it has not slipped in- 

 ward along the median side of the tooth, pressing the in- 

 ternal plate away from the tooth row and tending to pro- 

 duce a longitudinal fracture nearly or quite as long as the 



