The early eruption of the first permanent molars makes them more prone to dental caries which can be severe leading to loss of pulp vitality.Pulp vitality is crucial for the completion of root maturation following tooth eruption. Loss of pulp vitality before complete root maturation will in cessation of root development leaving the tooth with wide open root apex and thin dentinal walls with/without blunderbuss root configuration.Endodontic procedures for these immature non-vital molars are considered to be challenging for any dentist due to the absence of apical constriction and hence difficulty to obtain an apical seal upon which an obturating material can be condensed.Alternative treatment modalities include: calcium hydroxide apexification and MTA apical barrier. None of these procedures have succeeded to stimulate root maturation, in terms of increase of root length and thickness, but relied only on the formation of a calcific barrier at the root end leaving the tooth with short roots and thin dentinal walls.Extraction of these immature molars is considered as a treatment option based on the assumption that the second permanent molar would drift mesially in place of the first permanent molar. Incorrect planning for their extraction would result in orthodontic problems.