Survival Rate of Teeth with a C-shaped Canal after Intentional Replantation: A Study of 41 Cases for up to 11 Years



      Teeth with a C-shaped canal have been regarded as a challenge for nonsurgical root canal treatment (RCT) and apical microsurgery because of their anatomic variations and low accessibility. For such teeth, intentional replantation might be a treatment option. The purpose of this study was to investigate the prognostic factors for the clinical outcome of intentionally replanted teeth with a C-shaped canal.


      We retrospectively investigated patients who had undergone intentional tooth replantation at the Department of Conservative Dentistry, Yonsei University Dental Hospital, Seoul, Korea, from June 2002 to November 2015. Consequently, 41 intentionally replanted teeth with C-shaped canals were identified. The cumulative survival rate and related prognostic factors were assessed based on clinical and radiographic examination using survival analysis.


      The cumulative survival rate of intentionally replanted teeth with a C-shaped canal was 83.4% at 4 years and 73.0% at 11 years postoperatively. Based on Cox proportional hazard regression analysis, extraoral time (≤15 minutes vs >15 minutes) and retrofilling material (ProRoot MTA [Dentsply, Tulsa, OK] vs others) were significantly associated with tooth survival (P < .05).


      Extraoral time exceeding 15 minutes and the use of ProRoot MTA as a retrofilling material were significantly associated with a lower survival of intentionally replanted teeth with C-shaped canals. With improved clinical procedures based on an understanding of the prognostic factors, intentional replantation would be a favorable treatment option for treating teeth with a C-shaped canal.

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        • Bender I.B.
        • Rossman L.E.
        Intentional replantation of endodontically treated teeth.
        Oral Surg Oral Med Oral Pathol. 1993; 76: 623-630
        • Cooke 3rd, H.G.
        • Cox F.L.
        C-shaped canal configurations in mandibular molars.
        J Am Dent Assoc. 1979; 99: 836-839
        • Torabinejad M.
        • Dinsbach N.A.
        • Turman M.
        • et al.
        Survival of intentionally replanted teeth and implant-supported single crowns: a systematic review.
        J Endod. 2015; 41: 992-998
        • Raghoebar G.M.
        • Vissink A.
        Results of intentional replantation of molars.
        J Oral Maxillofac Surg. 1999; 57: 240-244
        • Emmertsen E.
        • Andreasen J.O.
        Replantation of extracted molars. A radiographic and histological study.
        Acta Odontol Scand. 1966; 24: 327-346
        • Choi Y.H.
        • Bae J.H.
        • Kim Y.K.
        • et al.
        Clinical outcome of intentional replantation with preoperative orthodontic extrusion: a retrospective study.
        Int Endod J. 2014; 47: 1168-1176
        • Andreasen J.O.
        • Borum M.K.
        • Jacobsen H.L.
        • Andreasen F.M.
        Replantation of 400 avulsed permanent incisors. 4. Factors related to periodontal ligament healing.
        Endod Dent Traumatol. 1995; 11: 76-89
        • Silva E.J.
        • Nejaim Y.
        • Silva A.V.
        • et al.
        Evaluation of root canal configuration of mandibular molars in a Brazilian population by using cone-beam computed tomography: an in vivo study.
        J Endod. 2013; 39: 849-852
        • Sinanoglu A.
        • Helvacioglu-Yigit D.
        Analysis of C-shaped canals by panoramic radiography and cone-beam computed tomography: root-type specificity by longitudinal distribution.
        J Endod. 2014; 40: 917-921
        • Amoroso-Silva P.A.
        • Ordinola-Zapata R.
        • Duarte M.A.
        • et al.
        Micro-computed tomographic analysis of mandibular second molars with C-shaped root canals.
        J Endod. 2015; 41: 890-895
        • Jin G.C.
        • Lee S.J.
        • Roh B.D.
        Anatomical study of C-shaped canals in mandibular second molars by analysis of computed tomography.
        J Endod. 2006; 32: 10-13
        • Jafarzadeh H.
        • Wu Y.N.
        The C-shaped root canal configuration: a review.
        J Endod. 2007; 33: 517-523
        • Kato A.
        • Ziegler A.
        • Higuchi N.
        • et al.
        Aetiology, incidence and morphology of the C-shaped root canal system and its impact on clinical endodontics.
        Int Endod J. 2014; 47: 1012-1033
        • Solomonov M.
        • Paque F.
        • Fan B.
        • et al.
        The challenge of C-shaped canal systems: a comparative study of the self-adjusting file and ProTaper.
        J Endod. 2012; 38: 209-214
        • Seo D.G.
        • Gu Y.
        • Yi Y.A.
        • et al.
        A biometric study of C-shaped root canal systems in mandibular second molars using cone-beam computed tomography.
        Int Endod J. 2012; 45: 807-814
        • Gu Y.C.
        A micro-computed tomographic analysis of maxillary lateral incisors with radicular grooves.
        J Endod. 2011; 37: 789-792
        • Martins J.N.
        • Mata A.
        • Marques D.
        • et al.
        Prevalence and characteristics of the maxillary C-shaped molar.
        J Endod. 2016; 42: 383-389
        • Tronstad L.
        • Asbjornsen K.
        • Doving L.
        • et al.
        Influence of coronal restorations on the periapical health of endodontically treated teeth.
        Endod Dent Traumatol. 2000; 16: 218-221
        • Andreasen J.O.
        • Hjorting-Hansen E.
        Replantation of teeth. I. Radiographic and clinical study of 110 human teeth replanted after accidental loss.
        Acta Odontol Scand. 1966; 24: 263-286
        • Andreasen J.O.
        Effect of extra-alveolar period and storage media upon periodontal and pulpal healing after replantation of mature permanent incisors in monkeys.
        Int J Oral Surg. 1981; 10: 43-53
        • Van Hassel H.J.
        • Oswald R.J.
        • Harrington G.W.
        Replantation 2. The role of the periodontal ligament.
        J Endod. 1980; 6: 506-508
        • Andreasen J.O.
        Periodontal healing after replantation and autotransplantation of incisors in monkeys.
        Int J Oral Surg. 1981; 10: 54-61
        • Hammarstrom L.
        • Blomlof L.
        • Lindskog S.
        Dynamics of dentoalveolar ankylosis and associated root resorption.
        Endod Dent Traumatol. 1989; 5: 163-175
        • Bernardes R.A.
        • de Souza Junior J.V.
        • Duarte M.A.
        • et al.
        Ultrasonic chemical vapor deposition-coated tip versus high- and low-speed carbide burs for apicoectomy: time required for resection and scanning electron microscopy analysis of the root-end surfaces.
        J Endod. 2009; 35: 265-268
      1. AAE and AAOMR Joint Position Statement: use of cone beam computed tomography in endodontics 2015 update.
        J Endod. 2015; 41: 1393-1396
        • de Paula Reis M.V.
        • Moura C.C.
        • Soares P.B.
        • et al.
        Histologic and micro-computed tomographic analyses of replanted teeth stored in different kind of media.
        J Endod. 2014; 40: 665-669
        • Hwang J.Y.
        • Choi S.C.
        • Park J.H.
        • Kang S.W.
        The use of green tea extract as a storage medium for the avulsed tooth.
        J Endod. 2011; 37: 962-967
        • Song M.
        • Jung I.Y.
        • Lee S.J.
        • et al.
        Prognostic factors for clinical outcomes in endodontic microsurgery: a retrospective study.
        J Endod. 2011; 37: 927-933
        • Song M.
        • Kim E.
        A prospective randomized controlled study of mineral trioxide aggregate and super ethoxy-benzoic acid as root-end filling materials in endodontic microsurgery.
        J Endod. 2012; 38: 875-879
        • Tsesis I.
        • Rosen E.
        • Taschieri S.
        • et al.
        Outcomes of surgical endodontic treatment performed by a modern technique: an updated meta-analysis of the literature.
        J Endod. 2013; 39: 332-339
        • von Arx T.
        • Jensen S.S.
        • Hanni S.
        • Friedman S.
        Five-year longitudinal assessment of the prognosis of apical microsurgery.
        J Endod. 2012; 38: 570-579
        • Choi Y.
        • Park S.J.
        • Lee S.H.
        • et al.
        Biological effects and washout resistance of a newly developed fast-setting pozzolan cement.
        J Endod. 2013; 39: 467-472
        • Torabinejad M.
        • Hong C.U.
        • McDonald F.
        • Pitt Ford T.R.
        Physical and chemical properties of a new root-end filling material.
        J Endod. 1995; 21: 349-353
      2. Keystone Industries. SuperEBA Instructions. Available at: Accessed June 12, 2016.

        • Song M.
        • Yue W.
        • Kim S.
        • et al.
        The effect of human blood on the setting and surface micro-hardness of calcium silicate cements.
        Clin Oral Investig. 2015 Dec 23; ([Epub ahead of print])
        • Nekoofar M.H.
        • Davies T.E.
        • Stone D.
        • et al.
        Microstructure and chemical analysis of blood-contaminated mineral trioxide aggregate.
        Int Endod J. 2011; 44: 1011-1018
        • Kim Y.
        • Kim S.
        • Shin Y.S.
        • et al.
        Failure of setting of mineral trioxide aggregate in the presence of fetal bovine serum and its prevention.
        J Endod. 2012; 38: 536-540
        • Sarkar N.K.
        • Caicedo R.
        • Ritwik P.
        • et al.
        Physicochemical basis of the biologic properties of mineral trioxide aggregate.
        J Endod. 2005; 31: 97-100
        • Rahimi S.
        • Ghasemi N.
        • Shahi S.
        • et al.
        Effect of blood contamination on the retention characteristics of two endodontic biomaterials in simulated furcation perforations.
        J Endod. 2013; 39: 697-700
        • Formosa L.M.
        • Damidot D.
        • Camilleri J.
        Mercury intrusion porosimetry and assessment of cement-dentin interface of anti-washout-type mineral trioxide aggregate.
        J Endod. 2014; 40: 958-963
        • Fernandes M.
        • de Ataide I.
        • Wagle R.
        C-shaped root canal configuration: a review of literature.
        J Conserv Dent. 2014; 17: 312-319
        • Jin G.C.
        • Kim K.D.
        • Roh B.D.
        • et al.
        Buccal bone plate thickness of the Asian people.
        J Endod. 2005; 31: 430-434