Periapical lesion is the most common sequelae of pulp necrosis due to either carious involvement or trauma. Treatment options to manage periapical lesion with open apex ranges from non-surgical root canal treatment and/or apical surgery to extraction. Objective: clinicall and radiogrphicall evaluation of the effect of MTA and bioceramic root canal sealer to manage immature permenant teeth with open apex. Methodology: The study was composed of sixty teeth from 54 children with age ranged from seven to ten years old age. Children were divided in to two equal groups: 1-Group A:Teeth were received apexification with MTA 2-Group B:Teeth were received apexification with bioceramic root canal sealer. All patients were followed clinically and radiographically immediate postoperatively, 3 and 6 months. Results: The success rate in both bioceramic and MTA was 93.3% and 90% respectively with no statistical significant difference. After 6 months, all teeth shows normal lamina dura among both bio ceramic and MTA groups. While, reduced radiolucences and obvious healing of bone detected among 93.3% and 90% of tooth among bio ceramic and MTA groups respectively. Conclusions: Both MTA and bioceramic sealer show good results