What is apexification of a permanent tooth?

What does it mean when a dentist says your tooth, or your child’s, needs apexification? It’s a treatment for a permanent tooth whose root hasn’t finished growing and whose pulp has died. It places a barrier at the open root tip so the tooth can be filled and sealed.¹ Knowing the steps can make that conversation feel much less unfamiliar. 

What you will learn in this article: 

• What apexification is and why the tip of a tooth root matters 

• Why a permanent tooth with an unfinished root may need treatment 

• How apexification compares with other treatments for developing teeth 

• What the procedure can accomplish and what to expect afterward 

Have questions about saving a damaged tooth? Schedule an appointment with an Aspen Dental provider. 

What does apexification mean? 

Apexification creates a barrier at the end of an incompletely developed root when the pulp inside the tooth has died. Dentists call the root tip the apex. The barrier helps keep the root canal filling inside the tooth.¹

Teeth are not solid all the way through. Inside each tooth is soft tissue called the pulp. It contains nerves and blood vessels and helps the root develop.² When that tissue dies before growth is complete, the root may be left with thin walls and an open tip.³

Why would a permanent tooth need apexification? 

A permanent tooth can need apexification when its root is still unfinished and its pulp is no longer alive.¹ A tooth can be visible in the mouth while the root is still developing underneath. 

An injury or deep decay can damage the pulp. Even a tooth that does not look chipped after an accident may have damage inside.² If this happens during development, the tooth may need a different approach from a fully developed tooth. 

Your dentist will use an examination, dental history and X-rays to understand the tooth's condition.¹ They may refer you to an endodontist, a dentist with additional training in treating the inside of teeth.² The goal is to find a way to keep the tooth, when possible. 

What does apexification treatment involve? 

The general goal is to create a firm stop at the open end of the root. The canal is cleaned and disinfected before the barrier and final filling are completed. Medication may be placed inside the tooth between appointments.¹

There are two approaches you may hear about: 

• Calcium hydroxide: Traditionally, this material was used over several months to encourage a hard tissue barrier to form. That approach requires repeated visits, and prolonged use has been linked to weakening of the root's dentin.³ 

• Mineral trioxide aggregate, or MTA: This material can be placed at the root tip as a barrier. It generally reduces treatment time and the number of visits compared with traditional calcium hydroxide apexification.³ 

Calcium hydroxide may also be placed for a short time, about two weeks to a month, to disinfect the canal before an MTA barrier is set.¹ An MTA barrier does not guarantee treatment in one appointment. Your provider can explain the stages, how the tooth will be sealed and when you’ll return.

How is apexification different from a root canal? 

Apexification addresses a problem that makes filling a young tooth more difficult: The root tip is still open. It provides a barrier so the canal can be filled.¹ Cleaning and sealing the canal are still needed. 

A conventional root canal removes damaged pulp, cleans the inside of the tooth and fills and seals that space.² Understanding what to expect before and after root canal treatment can help make those shared steps feel more familiar. 

How does apexification compare with apexogenesis? 

These words look similar, but they describe different goals. Apexogenesis means continued natural root development. Treatment that preserves healthy living pulp can allow that process to continue. Apexification is used when the pulp has died and the unfinished root needs an end barrier.¹

What about regenerative endodontic treatment? 

Regenerative treatment aims to encourage living tissue within the canal and may allow further root lengthening or thickening, though much of the evidence so far comes from case reports.⁴ That potential is different from creating an end barrier alone. Ask whether this is an option for your tooth. 

What can apexification accomplish, and what are its limits? 

Apexification helps make it possible to fill and seal a tooth with an open root tip. It does not, by itself, make the root grow longer or its walls thicker. Thin roots can remain vulnerable to fracture, including after MTA treatment.³

This does not mean the tooth cannot last. It means that closing the tip is only part of caring for it. Your provider will also plan the final restoration and follow-up visits. 

Follow-up checks help your provider assess healing and look for problems around the root.¹ Ask what they hope to see at each visit and how the tooth's condition affects its outlook. 

Have questions about treatment for you or your child? Schedule an examination with your local dental provider to talk through your options. 

What is apexification of a permanent tooth? FAQs 

Is apexification only for children? 

Not necessarily. The key issue is an incompletely formed root with pulp that has died, rather than age alone.¹ If you are an adult whose dentist has mentioned an open root tip, ask what caused it and how that affects treatment. 

Will I need a crown after apexification? 

Not necessarily. After endodontic treatment, the restoration depends on the tooth's location and how much healthy structure remains. Back teeth generally need crowns, while front teeth do not always need them.² Your dentist can explain the best fit for your tooth. A crown does not make an unfinished root continue growing. 

What happens if the tooth does not heal? 

Your endodontist will look for the reason before recommending another step. Further endodontic treatment or surgery may help save some teeth. A tooth that cannot be restored or has a severe root fracture may need removal.² Ask which options apply to your situation and what each would involve. 

Sources 

¹ American Academy of Pediatric Dentistry, The Reference Manual of Pediatric Dentistry: “Pulp Therapy for Primary and Immature Permanent Teeth.” https://www.aapd.org/globalassets/media/policies_guidelines/bp_pulptherapy.pdf 
² American Association of Endodontists: “Root Canal Explained.” https://www.aae.org/patients/root-canal-treatment/what-is-a-root-canal/root-canal-explained/ 
³ American Association of Endodontists: “Regenerative Endodontics.” https://www.aae.org/specialty/wp-content/uploads/sites/2/2017/06/ecfespring2013.pdf 
⁴ American Association of Endodontists: “Scope of Endodontics: Regenerative Endodontics.” https://www.aae.org/specialty/wp-content/uploads/sites/2/2018/07/2018AAE_Scope_of_Endo_Regenerative_Endodontics.pdf