Inclusion Criteria:  All the patients attending the primary care dental clinic with deep caries and/or pain in a permanent premolar or molar tooth.  Teeth with complete radicular growth. Preoperative symptoms of irreversible pulpitis (Spontaneous pain or exacerbated by thermal stimuli and lasting for a few seconds to several hours interpreted as lingering pain compared with a control tooth and that could be reproduced using thermal testing)  Exclusion Criteria:  Medically comprised or pregnant patients.  Teeth exclusion criteria: Pathological mobility Sinus tract Teeth that cannot be restored with amalgam Radiographic internal or external resorption Presence of apical rarefaction