Management of immature necrotic permanent teeth imposes a challenge to the clinician as they cannot be managed with routine endodontic treatment. To treat such a tooth; thorough disinfection of the root canal system followed by an apical barrier to obturate the canal is required. This case report demonstrates management of an anterior necrotic tooth with an open apex using Mineral Trioxide Aggregate (MTA) for apexification. The tooth was thoroughly disinfected using antimicrobial irrigants. Calcium hydroxide dressing was given for a period of 1 week followed by an apical plug of 4-5 mm of MTA. A fiber post and composite core were given to finally restore the tooth with a full coverage crown. The positive clinical outcome of the case supports the use of MTA apexification for the management of open apex.

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