## 4 Discussion
The unpredictable properties of MTA mainly stem from its manufacture from natural materials, which results in compromises on purity, particle size, etc. Thus, efforts have been made to synthesize similar materials. These efforts spawned a new class of calcium silicate materials, including Bioaggregate, Biodentine, EndoSequence materials and iROOT BP Plus. Calcium silicate based cement (MTA, Biodentin and iRoot) showed good pulp-capping properties (biocompatibility, inductive effect and tissue response), and no material was superior to the other. They all seemed to form good quality dental bridges with minimal inflammation [19; 20; 21]. Recent evidence suggests that immediate adhesive restoration after the use of silicate materials such as MTA produces acceptable results. MTA can therefore be used in immediate restorations in a single sitting [22]. Biodentine was formulated by Septodont in 2009 as an alternative to MTA. However, the calcium silicate is completely synthetic with a uniform particle size and is free from impurities. The presence of a hydrosoluble polymer (super-plasticizer) reduces porosity. It is marketed as a \"dentine substitute material\", claiming properties and behaviors similar to those of dentine. Biodentine is claimed to possess superior compressive strength (304 MPa vs. 67 MPa after 21 days) and flexural strength compared to MTA [20]. Reparative dentin formed with Biodentine-restored vital pulps was a tubular orthodontic, without the tunnel defects observed in calcium hydroxide. Additionally, the absence of disadvantageous weak aluminates (present in MTA) seems to contribute to its strength [23; 24; 25]. A recent systematic review evaluated the material properties and clinical applications of Biodentine and found superior strength and less microleakage when compared to MTA. Both materials were associated with TGF-\(\beta\) expression in pulp cells and performed similarly as pulp-capping materials [26]. Therefore, Biodentine is seen as a good alternative to MTA, with better handling, short setting time, higher strength and improved calcium release. However, more data on long-term clinical outcomes are required [27; 28; 29; 30; 31; 32; 33; 34]. ERRM is a bioceramic material recently developed by Brasseler USA. It is composed of calcium silicate, zirconium oxide, tantalum oxide, calcium phosphate and fillers. ERRM is premixed and hardens in the presence of moisture and therefore is ideal against dental walls [35]. Cell culture studies have reported its biocompatibility and antibacterial effects. The alkaline pH induced by the material is said to result in increased calcium release and hydroxyapatite formation. The antibacterial effects are persistent even after setting [36; 37]. The results of the present study are largely in agreement with a 2016 study that compared MTA and ERRM as pulp-capping agents and found that both MTA and ERRM stimulate well-formed dentin-like tissue with minimal inflammation. There were no statistically significant differences between the two agents. However, they observed that MTA was superior in forming the dentinal bridge [38]. Although there are promising results obtained with newer materials like ERRM, it is vital to acknowledge that long-term studies similar to those of MTA are lacking with ERRM [39, 40].