It is a point of interest in endodontics, as it is considered necessary to thoroughly chemomechanically debride the pulp space to remove all necrotic tissue and minimise bacterial load in the pulp space. Ideally this debridement would terminate exactly at the apical foramen. In reality determining the exact position of the apical foramen is problematic, requiring radiography and/or use of an electronic apex locator to produce a refined estimate. A tooth may have multiple small accessory canals in the root apex area forming an apical delta which can complicate the endodontic problem.
An apical constriction is often present. In immature teeth the root is not fully formed leading to an open apex. This is also seen in some pathological teeth.