## 4 Discussion  
### Biodentine and MTA+  
This study revealed no significant difference in the success rates between the MTA+ (92%) and Biodentine (64%) groups. Both materials have demonstrated efficacy in treating various exposed mature permanent teeth. The results with MTA+ align with previous studies using the widely used ProRoot MTA. MTA+, a cost-effective alternative, retains the proven benefits of MTA, which is widely regarded as the gold-standard material for VPT due to its excellent sealing ability, biocompatibility, and long-term clinical success [15]. [PERSON] et al. reported a 91.8% success rate for complete pulpotomy in mature permanent molars using ProRoot MTA [21]. Similarly, [PERSON] et al. [22] achieved a 92% success rate for partial pulotomy in maxillary and mandibular molars with irreversible pulpitis using \begin{table}
\begin{tabular}{l l l l l l} \hline \hline
**Factor** & **Comparator Level** & **OR** & **95\% CI Lower** & **95\% CI Lower** & \(p\)**-Value** \\ \hline material (reference: & & 0.14 & 0.01 & 1.84 & 0.136 \\ MTA+) & mild & 0.66 & 0.05 & 9.56 & 0.762 \\ [PERSON] diagnosis & moderate & 0.55 & 0.02 & 15.78 & 0.725 \\ (reference: initial) & severe & 0.48 & 0.01 & 17.57 & 0.691 \\ sex (reference: female) & male & 1.19 & 0.14 & 9.81 & 0.872 \\ age & & 1.00 & 0.92 & 1.08 & 0.912 \\ \hline \hline \end{tabular} \(\mathbb{C}\): confidence interval, MTA+: Mineral Trioxide Aggregate Plus, OR: odds ratio.  
\end{table} 
Table 4: Effect of pulpal state based on Wolters criteria on the odds ratio (OR). \begin{table}
\begin{tabular}{l l l l l l} \hline \hline
**Factor** & **Comparator Level** & **OR** & **95\% CI Lower** & **95\% CI Lower** & \(p\)**-Value** \\ \hline material (reference: & & 0.14 & 0.01 & 1.84 & 0.136 \\ MTA+) & mild & 0.66 & 0.05 & 9.56 & 0.762 \\ (reference: initial) & moderate & 0.55 & 0.02 & 15.78 & 0.725 \\ sex (reference: female) & severe & 0.48 & 0.01 & 17.57 & 0.691 \\ sex (reference: female) & male & 1.19 & 0.14 & 9.81 & 0.872 \\ age & & 1.00 & 0.92 & 1.08 & 0.912 \\ \hline \hline \end{tabular} \(\mathbb{C}\): confidence interval, MTA+: Mineral Trioxide Aggregate Plus, OR: odds ratio.  
\end{table} 
Table 5: Effect of treatment modality on the odds ratio (OR). \begin{table}
\begin{tabular}{l l l l l l} \hline \hline
**Factor** & **Comparator Level** & **OR** & **95\% CI Lower** & **95\% CI Lower** & \(p\)**-Value** \\ \hline material (reference: & & 0.11 & 0.01 & 1.52 & 0.100 \\ MTA+) & partial pulmonary & 0.11 & 0.01 & 2.00 & 0.138 \\ direct pulp capping) & complete & 0.21 & 0.01 & 4.23 & 0.308 \\ sex (reference: female) & male & 0.81 & 0.09 & 7.51 & 0.856 \\ age & & 1.01 & 0.92 & 1.10 & 0.907 \\ \hline \hline \end{tabular} \(\mathbb{C}\): confidence interval, MTA+: Mineral Trioxide Aggregate Plus, OR: odds ratio.  
\end{table} 
Table 3: Effect of pulpal state based on AAE criteria on the odds ratio (OR). the same MTA. A recent meta-analysis [15] confirmed the non-inferiority of Biodentine (77.9%) compared to MTA (92%). Both bioactive cements exhibit comparable biological properties for VPT, including high biocompatibility, odontogenic potential, low inflammatory response, angiogenic activity, and antibacterial effects [22]. However, despite these shared biological characteristics, they differ in physical properties such as handling, setting time, and cost, which may influence material selection in clinical practice [14]. While both materials demonstrated favorable outcomes, MTA tended to have a higher success rate in this study. The overall clinical success rate in the first six months for the Biodentine group was lower than the success rates reported in previous studies [21; 22]. This discrepancy may be attributed to the strict success criteria applied in this investigation, such as the classification of negative cold response cases as a failure. Biodentine is suitable as a single-visit VPT material with a claimed setting time of 12 min.