Management of Immature Apices

There are a variety of reasons for infection in the root of a tooth. In children, one of the most common reasons is known as immature apices. In this situation, conventional root canal treatment usually is not an option, because the outcomes when dealing with immature apices are not as predictable. Often, these patients have traumatized anterior (front) teeth or carious exposures in the posterior (back). On occasion, dental anomalies such as dens evaginatus or dens invaginatus present a unique challenge. We specialize in treating and managing immature apices. The most common procedures (described in greater detail later on this page) we use in this treatment include:

  • Apexogenesis
  • Apexification
  • Revascularization

What does “immature apices” mean?

The apex of the tooth is the tip of the root. Your front teeth only have one apex at the end of the single root, while molars have multiple roots that form an apical foramen. So, the “apices” are referring to the plural form of the teeth with multiple roots. To better understand the anatomy of the tooth, see the diagram below. As seen in the diagram, the tooth apices are at the roots of the tooth.

While teeth are maturing, the apices are open. The tooth apices do not close until the teeth fully develop. So immature apices are referring to teeth that still need to develop to fully close the apices. Immature apices are most common in children or people under the age of 18.

Treatment of Immature Apices

Conventional root canal treatment is usually not the best treatment for immature teeth. The reason for this is because outcomes are not as predictable as they are with mature teeth. This is why general dentists usually refer these patients to endodontists. Endodontists are experts in treating infection in the root. They also use additional treatment options to deal with immature apices such as apexogenesis or apexification that may be better suited as treatment. These treatment options help to improve the chance of saving the tooth.


Apexogenesis is a procedure that encourages the root to continue development as the pulp is healed. The endodontist places medication on the soft tissue to encourage the development. The walls of the root canal will thicken as the child gets older. If the pulp heals, no additional treatment will be necessary. If the pulp is unhealthy, then most dentists recommend apexification.


In the process of apexification, the endodontist removes the unhealthy pulp. They then place medication into the root to help a hard tissue form near the root tip. This provides a barrier for the root canal filling. The tooth will not continue to develop, making the tooth susceptible to fracture.

Schedule an appointment

If your child gets an infection in his/her tooth before the roots are fully formed, call our office. Our doctors will be able to do a full evaluation and give you the best recommendation for the appropriate treatment.

If you have any questions or would like to schedule a consultation visit our Contact Page to submit a form or call our office at (213) 388-3636