Surgical trephination was commonly used to reduce inflammation and infection in the periapical tissues as an emergency procedure, and the origins of this technique can be traced back to the mid 1800s. Its use has been both advocated and condemned by many of dentistry's pioneers, with similar, mixed feelings expressed by some of today's clinicians. More recent studies have questioned the value of this technique in the reduction of pain and swelling, along with the safety and efficacious nature of the procedure. However, although the technique may have fallen out of favour with many contemporary clinicians who chose to manage endodontic emergencies with antibiotics and powerful analgesics, its goals are still laudable and its clinical value in the hands of a skilled clinician can still be of great benefit to the patient. Keywords: incision and drainage, periapical pain, pulpal and periapical emergencies, surgical trephination