4. Discussion
bleeding, milk teeth, discoloration, tooth, teeth, pulpal bleeding
BLEEDING, CYTOTOXICITY, DECAY
To the extent of the authors' knowledge, few data are published on the effectiveness of TheraCal in pulpotomy of the primary molar. On the other hand, MTA is considered an ideal material for this purpose having excellent biocompatibility properties. However, its high cost, difficult handling, long setting time, and probability of discoloration have limited its usage expansion [In the current study, MTA was applied as the control because of the numerous properties that have made it the gold standard material for pulpotomy in primary teeth. Its features include biocompatibility, bioinductivity, physical strength, antimicrobial effects, and proper sealing [According to the findings from the used evaluative methods in our study, the MTA-treated primary molars showed a 100% clinical success rate at both 6-month and 12-month follow-up sessions. To the present findings, some other studies have mentioned similar clinical success rates for the MTA material [In both MTA and TheraCal groups, radiographic failures were more common than clinical ones. However, MTA and TheraCal showed no periapical radiolucency. This can be explained by their appropriate coronal seal and high resistance against penetrating bacteria into the periapical areas. Parallelly, GI capped with SSC was used to reduce the microleakage along with the entire restoration interface [Similar to some other studies, no external or internal resorption was observed in the MTA-treated teeth [The setting mechanism and calcium releasing properties of TheraCal are modified due to the presence of resin matrix in its formulation, for example, lower solubility and higher calcium release compared to the self-setting calcium hydroxide and ProRoot MTA [The most important concern about biomaterials used in pulpotomy is their biocompatibility and cytotoxicity since the material contacts directly to the pulp. Free uncured resin monomers in resin-modified materials such as TheraCal may have a cytotoxic effect [Overall, our findings demonstrated remarkable results of TheraCal in pulpotomy of primary teeth at the 12-month follow-up. Therefore, TheraCal can be considered as an alternative material in the pulpotomy of primary teeth.Exposure location is an important determining factor; occlusal exposures are more successful than proximal ones. A five-minute guideline is provided by an expert, but there is evidence that failure to control bleeding may lead to reduced success in DPCs and reinforces the need to use direct clinical observation in diagnosis and decision-making. Absence of symptoms and preservation of pulp vitality after at least one year indicates a successful VPT. Another factor that affects the success of direct pulp cap is the ability to control pulpal bleeding after exposure and before pulpal bleeding. If the tooth is asymptomatic and well filled, even if the decay remains, the tooth's chances of survival are excellent [It is important to note the limitations of this study since they can determine the future direction of the present study. Firstly, it was the potential release of free monomers from TheraCal that its effect on reducing the biocompatibility was not well-known. Second, we did not observe the histological quality of dentin bridges under TheraCal. Meanwhile, with the precise histological examination of the treated teeth, a more understanding of the effect of TheraCal in pulpotomy milk teeth can be obtained. Finally, a larger sample size with long-term follow-ups until the exfoliation of treated teeth is suggested to assess the histologic results more accurately in different groups.