Mineral trioxide aggregate (MTA) has emerged as a reliable bioactive material with extended applications in endodontics that include the obturation of the root canal space. This article examines the literature supporting MTA as a canal filling material, suggests methods for its delivery and placement, and presents clinical cases that demonstrate its effectiveness in resolving apical periodontitis under a variety of circumstances. Case reports are presented documenting clinical outcomes after the application of MTA that include retreatment, obturation combined with root-end resection, apexification, internal resorption, dens in dente, and in conventional endodontic therapy. The review introduces clinicians to an alternative treatment strategy that might improve the healing outcomes for patients presenting with complex and challenging endodontic conditions.