Fig. 1

A 34-year-old male patient presented in our private endodontic office for evaluation of tooth 21, which had received nonsurgical endodontic treatment years ago caused by trauma. The presenting symptoms included swelling in the buccal vestibule and pain. His health history was unremarkable and radiographic examination revealed two fiber post into the root, incomplete sealing associated with extensive periapical bone loss. Clinical examination disclosed fluctuant swelling in the vestibule, no mobility and pain on percussion. The diagnosis was acute peri-apical abscess, after discussing treatment options, we decided on an orthograde retreatment. The patient was informed of the pros and cons of the treatment and informed consent was obtained.

Fig. 2

In this image we can see the preoperative situation and the location of the fiber post. 

Fig. 3

After anesthesia the tooth was isolated

The Fiber Post was removed using ultrasonic tip. 

Old guttapercha was removed using Hedstrom FIles

After removing the old gutta-percha, we discovered a second fiber post in the vestibular wall.

Fig. 4

The  canal was chemomechanically shaped and cleaned using the following protocol:

Desobturation Technique : Hedstrom Files

Shaping : Protaper Next X1- X5 , K Files 60/70/80

Irrigation; Sodium hypochlorite 5,25% + Saline Solution + Edta 17%  PUI + sodium hypochlorite 5,25% PUI

Fig. 5

After cleaning, disinfecting and dry the root canal we proceed to seal it. In this case, we could not ensure a correct seal with conventional gutta-percha (due to the large apical gauge), we decided to seal with MTA plug. 

For this process we use the Map System carrier ( Needle Nº 2 ), which ensures easy and predictable handling of the MTA.

This video shows the  Apical Plug Technique

Fig. 6

In this picture we can see the  apical Plug.

Fig. 7

Final Xray

Fig. 8



The MTA apical plug technique is a repeatable, predictable and safe technique in cases with open apex or incomplete root development. We must know and handle this type of technique to ensure a correct apical seal in all cases.


Gorni FG, Gagliani MM. The outcome of endodontic retreatment: a 2-yr follow-up. J Endod. 2004 Jan;30(1):1-4.

Torabinejad M, Corr R, Handysides R, Shabahang S. Outcomes of nonsurgical re- treatment and endodontic surgery: a systematic review. J Endod 2009;35:930–7