PMC3021853_01
Case 1: Radiography at the first visit showing radiolucency at the apex area of tooth 46.
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Deep caries were detected in tooth 25, and radiolucency was detected in the periapical lesion (Figure 2).
Case 1: Result of a chairside anaerobic culture test at the first visit showing thick bacterial lines.
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Minimal pus was exuded from the root canal, but the chairside anaerobic culture test revealed large amounts of bacteria in the root canal; solid lines of bacterial colonies were detected from the top to the bottom of the culture plate (Figure 3).
Case 1: Result of a chairside anaerobic culture test at the second visit showing thin and dotted bacterial lines.
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The anaerobic culture test showed some solid lines followed by dotted lines, indicating that the bacterial load was decreasing compared to the first visit (Figure 4).
Case 1: Radiography of the root canal filling showing remaining bone loss at the root apex.
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At the fourth visit (22nd day), the root canal was filled with gutta-percha points and root canal sealer (Canals, Showa Yakuhin Kako Co., Ltd., Tokyo, Japan) with a lateral condensation method (Figure 5).
Case 1: Radiography 2 months after the initial visit showing that the radiolucency at the apex had decreased.
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Two months after the initial visit, the radiolucency was diminishing (Figure 6).
PMC3021853_02
Case 2: Radiography at the first visit showing radiolucency at the apex area of tooth 46.
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Deep caries were present in tooth 46, and a large radiolucency was observed in the periapical lesion (Figure 7).
Case 2: Result of a chairside anaerobic culture test at the third visit showing several kinds of bacterial colonies including black-pigmented bacteria.
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At the third visit (12th day), pain had completely disappeared, but many different types of colonies remained on the culture plate (Figure 8), including black-pigmented bacteria (BPB), which indicated a mixed infection of the root canal.
Case 2: Result of a chairside anaerobic culture test at the fourth visit showing scattered bacterial colonies.
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Pus discharge was not observed at the fourth visit (19th day), and the quantity of bacteria had decreased at this time (Figure 9).
Case 2: Radiography at the root canal filling showing remaining bone loss at the root apex.
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When the absence of endodontic bacteria was confirmed at the fifth visit (26th day), the root canal was filled with gutta-percha points as described above (Figure 10). Radiolucency was still observed at the apex of the distal root (Figure 10).
Radiography 10 weeks after the initial visit showing that the radiolucency at the apex had decreased.
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The radiolucency was improving 10 weeks after the initial visit (Figure 11).