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Objective To evaluate the clinical effects of mineral trioxide aggregate (MTA) as apulp⁃dressing agent in immature permanent anterior teeth. Methods 68 permanent anterior teeth with deep caries or accidental pulp expo⁃ sure were randomly divided into treatment group (MTA) and control group (calcium hydroxide). The exposed pulps were treated permanently with direct pulp capping. The effect of potential clinical variables on the treatment outcome was evaluated clinically and radiographically during a 24⁃month follow⁃up. In order to assess the cumulative successes, data were analyzed with chi ⁃square test and log ⁃ rank test (α= 0.05). Results The successful rate of the treatment group (91.4%) was higher than that of the control group (60.6%) significantly (P < 0.05). None of the gender, occlusal site, type of pulp exposure, site and diameter of pulp exposure had a considerable influence on the outcome (P > 0.05). Con⁃ clusion MTA as a biocompatable, osteogenesis⁃inducing and inflammation⁃controlling material appears to be suitable for direct pulp capping.