Inclusion criteria:
A vital molar tooth (confirmed with cold spray and electric pulp tester before treatment and visual inspection of pulpal hemorrhage after access cavity preparation)
A history of pain indicating irreversible pulpitis (i.e. spontaneous localized/generalized pain, pain stimulated by hot and cold fluids that lasts after elimination of the stimulus and is reproducible with cold testing)
Pulp exposure during caries removal when no sign of irreversible pulpitis is present
Patients in the range of 12 to 65 years
Patients who accept to attend for recalls
Patients who approve and sign the written informed consent
Exclusion criteria:
Patients with systemic conditions that disturbe tissue healing process (including diabetes, cancer, endocrine diseases, AIDS and consumption of corticosteroids)
Patients with epinephrine intolerance
Pregnant/nursing women
Physically disabled or mentally retarded patients
Patients with poor oral hygiene or those with periodontal diseases, where the long term preservation of the tooth may not be possible
Immigrants such as those from Afghanistan, who are likely to leave the country during the subsequent two years
Patients younger than 12 (for 1st molar treatment) and 17 (for 2nd molar treatment) and patients older than 65;
Non-vital/partially necrotic teeth confirmed with primary examinations or diagnosed after access cavity preparation
Teeth with pulpal inflammation spreading beyond the canal orifices, and continuous bleeding after placement of cotton pellet soaked in 2.5% sodium hypochlorite for a maximum of 10 minutes
Teeth that are not appropriate candidates for class I and II (Occlusal, MO, DO, MOD) restoration and require complicated build-ups, crown lengthening or prosthetic crown
Teeth with localized periodontal disease (i.e. probing depth more than 3 mm) where the tooth survival is not endangered but pulpal irritation and disturbed healing due to root exposure is likely
Internal/external root resorption or pulp calcification detectable in periapical radiography
Teeth with history of trauma
Swelling of surrounding soft tissues
Teeth with immature apices
Presence of sinus tract