## 4 Discussion  
CBCT demonstrated the superior performance of MTA and ERRM in dentinal bridge formation. All teeth capped with the four agents showed dentinal bridging, thus reinforcing current knowledge that all four materials are acceptable for pulp-capping. Histological analysis of the decalcified teeth sections stained with hematoxylin and eosin revealed that two-thirds (67%) of MTA- and ERRM-treated teeth developed structures similar to tubular dentin in the interface between the capping material and the pulp tissue. Nonspecific calcifications and atubular/amorphous dentin were predominant in teeth filled and capped with calcium hydroxide and Biodentine. As with the CT scan results, the histological findings in the teeth treated with calcium hydroxide are concordant with earlier studies [2; 6; 7; 8; 9; 10; 11; 12; 13; 14]. Earlier studies by [PERSON] and [PERSON] (2014) and others [2; 3; 4; 8; 10] reported high scores of dentinal bridge formation by MTA compared to calcium hydroxide in CBCT scan and histological evaluation. Our study affirms the superiority of MTA as a pulp-capping agent and shows that ERRM performs similarly, with identical CT scan scores and slightly lower histological scores. Our findings suggest that ERRM may be a good alternative material to MTA. The results of our study concerning Biodentine differ from earlier work done by [PERSON] et al. and [PERSON] et al. [21; 32; 33]. Biodentine also stimulated dentin-like material, but in fewer teeth compared to MTA and ERRM. Histologically, Biodentine stimulated a stronger pulpal response compared to the other agents. This may be due to its chemical composition and workability characteristics. [PERSON] et al. reported a higher TGF secretion by pulpal cells treated with Biodentine. The scientific file of the manufacturer states that \"when compared to ProRoot MTA, Biodentine demonstrates at least equivalent biocompatibility\". The file further notes that VEGF and FGF-2 (angiogenic mediators) were found to be enhanced in Biodentine-induced pulpal cells [24]. Therefore, we may infer that such mediator stimulation may be proinflammatory for the pulp. Biodentine is available as a  
Figure 6: Pulp score comparison among the pulp-capping agents (0—no inflammation; 1—mild inflammation; 2—moderate; 3—severe). powder liquid formula, thereby making the mixing ratio subject to worker errors. The presence of a hydro-polymer might also be an inflammatory stimulus for the pulp. The inflammatory response of calcium hydroxide treated teeth is similar to that of Biodentine-treated teeth, which is in line with many studies on calcium hydroxide as a pulp-capping material [32; 33; 34]. Bioceramics have been developed for several applications. They are defined as \"cramic products or components employed in medical and dental applications, mainly as implants and replacements that have osteoinductive properties\". MTA is one of the earliest biooceramic materials introduced [17]. MTA has been used in dental clinics for more than 2 decades since its discovery by [PERSON] in 1993 and FDA approval in 1997. The active components are tricalcium silicate, dicalcium silicate and tricalcium aluminate. [PERSON] et al. reported a close physicochemical seal between MTA and dentine, with faster initial dentine bridge formation and good healing. The major advantage of MTA is its stability in moist tissue. It is reported to have an inductive and a supportive function in the formation of dentinal bridges with fewer tunnel defects [10; 11; 12; 13; 14]. The drawbacks of MTA include its handling characteristics and long setting time (2 h 45 min) requiring two visits to complete the restoration. Grey MTA may cause an aesthetic compromise due to the presence of iron compounds. White MTA has been reported to cause discoloration due to the presence of the bismuth oxide radiopacifier, requiring a search for alternatives. Mixing results in a grainy mass that is difficult to introduce and condense at the exposure site [3; 10; 11; 12; 13; 14; 15; 16; 17; 18].