Clinical protocol Profound local anesthesia of each tooth was achieved by standard infiltration or inferior dental block injection with lidocaine and epinephrine (1:100000) (Xylestesin-A 3M ESPE, Seefeld, Germany). Then, the tooth was isolated with a rubber dam. The clinical crown was disinfected with a cotton pellet soaked in chlorhexidine. Caries were excavated using a round, high-speed diamond bur with adequate water cooling followed by a round carbide bur. Every attempt was carried to remove all carious tissue before exposing the pulp. A cotton pellet moistened with 5% NaOCl was placed into the cavity before pulpal exposure. The size of the pellet varied according to the size of remaining caries; there was no minimal pinpoint exposure of the pulp during caries removal due to the initial carious lesion was large and in close proximity to the pulp.