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By twisting the insertion tool before pulling it out, it puts a knot in the end of the plug, on the inside of the tire. I've never seen one come out, as long as the end is properly trimmed. The pressure really isn't as much as you think... most automotive tires are inflated to 60psi or less, and the typical hole in a tire is less than .25 square inches, so the pressure on the plug should be well under 20 lbs.

Good to know, so it is safe to use :) So far how many times have you used it?

In my personal vehicles, I've used these dozens of times. As a contractor, I'm frequently driving my vehicle into areas where people have left nails and screws laying around on the ground. Over the years, I must have installed hundreds of these plugs on different vehicles.

Cool :D Sounds like it takes the hit and supports it with ease :)