When the root is not fully developed, an apexification procedure is carried out. After thorough cleaning of the root canal, the calcium hydroxide is left for longer periods of time to give the root development a chance to continue. The intracanal medicament is usually changed after one month. After that, it is left for at least 6 months when a radiographic check-up is done. Usually the canal is cleaned again at this time and the canal is refilled with calcium hydroxide. Next radiographic check is done after another 6 months. If periapical healing and a closure of the root canal have taken place, the permanent root filling can be carried out. If root closure has not taken place, the tooth is checked again after another 6 months. Usually, an apexification procedure will give the desired result. However, in a few cases the root development will not continue and the canal has to be root filled without an apical stop.
Note 1: Apexification is a long term treatment that requires good temporary fillings.
Note 2: It is the elimination of infection from the root canal and not the action of calcium hydroxide that will make it possible for the body to continue root development. (It is possible to carry out an apexification procedure successfully without the use of calcium hydroxide. However, a temporary calcium hydroxide root filling is a good means to keep the canal clean and free from infection.)