Introduction: Mineral trioxide aggregate (MTA) has a variety of possible uses, including root-end filling material due to its excellent sealing ability in the presence of moisture and a high degree of biocompatibility. Aim: This case report demonstrates the use of MTA as an obturating material to promote periapical healing of root canals with large apical rarefactions. Materials and Methods: An 18-year-old female presented with a complaint of dental caries in the upper anterior region. Radiographic lesions were found with 4 mm and 10 mm sizes in the central and lateral incisors, respectively. The patient presented with swelling of gingiva and formation of fistula one month after filling of root canals. MTA was used as an apical filling material for the apical surgery. Discussion and Conclusions: This case reports how teeth that had large periapical lesions with recurring symptoms could be fixed with periapical surgery using MTA.