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Iamp;#39;m Joe Kemp and Iamp;#39;ve been a practicing endodontist for over 40 years Iamp;#39;ve also been teaching part-time throughout my career in the past treatment of teeth with open apices and necrotic pulps was very difficult this has been simplified with apical plug procedures utilizing pro route MTA when I began my career these teeth were considered hopeless for permanent retention development of Apex vacation treatments in the 1960s allowed us to save these teeth but the prognosis was still questionable the introduction of protrude MTA as an apical plug has completely changed the treatment and prognosis of these cases here are some examples here we have in this first case two maxillary central incisors with necrotic pulps open apices and big large lesions surrounding the apices once these teeth are cleansed in a routine endodontic manner the apices are then filled with a plug of 4 to 5 millimeters of depth of empro root MTA and then the remainder of the canal is bonded with
