Dilemmas in managing immature teeth
Immature teeth may require endodontic treatment in three different situations – as a result of developmental defects (such as dens evaginatus or dens invaginatus), as a result of caries, or following trauma to the tooth. Each situation needs to be managed differently as a result of the aetiology and the state of the tooth – in particular, the amount of coronal tooth structure. Each situation also poses several dilemmas. The ideal approach is to preserve the pulp wherever possible as this will lead to further root development and a stronger tooth, with a much better long-term prognosis. However, if the pulp has necrosed and become infected, then we are committed to doing some form of root canal treatment. There are three approaches to root canal treatment of immature teeth – each with its advantages and disadvantages, plus they all are associated with some misconceptions! The options are apexification, an apical plug procedure, or a repair procedure - the latter has been incorrectly called regeneration and revitalisation. The use of such terminology is one of the reasons why there are many misconceptions. Unfortunately, none of these three techniques address the real problem of an immature tooth – that is, the lack of dentine in the cervical region of the tooth which is where root fractures generally occur. This topic will be explored and treatment outcomes will be compared so practitioners can make informed decisions about their management of immature teeth in the different scenarios.

Learning Objectives
• Understand the conditions where immature teeth require root canal treatment
• Outline the potential complications associated with immature teeth that require root canal treatment
• Discuss the various approaches and techniques to endodontically manage immature teeth, including their advantages and disadvantages
• Discuss the aims of the various treatment approaches in light of their reported outcomes and the long-term prognosis of endodontically treated immature teeth