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site, it must be removed by opening the maxillary sinus in the classic manner.

Abscesses

When the osseous tissues have been crushed and extensively damaged, an abscess may occur on rare occasions. The symptoms include a swelling that persists after 48 hours and whose outline is rather sharply demarcated, with a firmness of the tissues. Fluctuation usually can be elicited by bimanual palpation. If the abscess persists, it can cause further bone resorption and gingival recession, with consequent food stagnation.

A mild abscess may be reduced by three or four local applications of 100 mg. oxytetracycline diluted in 2 or 3 cm. of serum. This solution is injected in situ through a syringe with a blunt needle. Usually by the third treatment the infection is eliminated.

A more severe abscess is treated by evacuating the pus through a 16-gauge needle or, preferably, by incising the area and allowing it to drain. If the patient is in a toxic condition, antibiotics should be administered systemically. If the patient does not respond satisfactorily to current therapy, a specimen of pus should be sent for culturing of the predominant microorganism so that a more exact method of treatment can be instituted.

Periostitis

Surgical trauma may cause inflammation of the periosteum. Such a condition is characterized by pain that begins immediately after surgery and can last for 12 to 24 hours. Treatment for the first 24 hours includes intennittent cold applications to the surgical site and the administration of an analgesic drug. After 24 hours the treatment is changed to intermittent applications of heat.

Septic periostitis may follow traumatic periostitis and be accompanied by alveolar osteitis (dry sock-et). The gingival tissues adjacent to the socket be-come inflamed, tender, and swollen, and the patient's temperature may be elevated. Septic periostitis is treated with an analgesic drug, systemic antibiotics, hot isotonic saline mouth rinses, and the extraoral application of hot moist packs.

Alveolar osteitis (dry socket)

Three to five days after surgery a severe throbbing pain that appears to involve the ear and/or the cervical region, as well as the implant site, may occur. This pain may be caused by a dry socket,

one in which the blood clot is either necrotic or absent. Generally the patient's temperature is normal, as is the mucosa adjacent to the socket, unless the condition is accompanied by septic periostitis. Dry socket is also characterized by a fetid odor.

The implant must be removed to treat the condition. The socket is then irrigated with a warm isotonic saline solution. The wound is examined for the presence of foreign bodies and, if necessary, a roentgenogram is taken. An anodyne (eugenol or guaiacol) or a topical anesthetic (butacaine sulfate, henzocaine, and so forth) is placed into the socket. The medication can be applied on a strip of sterile gauze or in the form of a paste.

The socket should not be curetted. Antibiotics should not be administered topically. Only in rare instances in which suppuration and an elevated temperature exist should systemic antibiotics be used. An analgesic drug should be prescribed. Depending on the severity of the pain, either an antipyretic analgesic or a narcotic, such as codeine sulfate ('/2 gr.) or meperidine (50 mg.), is used.

The patient should be reexamined in 24 hours. If pain persists, irrigation and dressing of the socket are repeated.

Acrylic burn

An acrylic burn may be caused by placing a cold cure acrylic splint directly in the mouth while the mix is still extremely loose. Leaving the splint in the mouth until it sets invites this complication. The resulting "burn," or an allergic reaction to the acrylic itself, is very painful and discomforting.

The pain can only be relieved by covering and protecting the affected mucosal tissues from irritation by the tongue, cheeks, and food. The area should be covered with a triamcinolone acetonide and Orabase salve, over which is placed an intraoral bandage. The dressing should be changed every day or two, according to the patient's pain. The patient must eliminate salty and crusty foods from his diet and restrict himself to a bland menu.

Acrylic burn usually persists for at least 10 days to 2 weeks. Removing and replacing the splint, letting it set outside the mouth, probably could have prevented this complication.

REMOVING FAILING IMPLANTS

Implants that have failed or are failing must be removed from their sockets to prevent their continued movement from causing further damage to the bone.