Aim: The aim of this study was to compare the effect of pulpotec and calcium hydroxide intracoronal dressing on inter-appointment pain relief for symptomatic posterior teeth with acute pulpitis with apical periodontitis. Materials and methods: The trial design followed the CONSORT 2010 flow diagram; the participants in this research were assigned into two groups, 22 patients in each group: randomly divided into two equal groups: GROUP A: will receive Calcium Hydroxide dressing GROUP B: will receive Pulpotec dressing. All selected participant subjected to Pulpotomy mechanically by removal of the irritant from the pulp chamber with leaving intact vital radicular pulp then chemically by using one of the comparable medicaments according to the allocated group followed by zinc phosphate base and restored finally with amalgam for all the teeth.The primary outcome that was the degree of pain relieving after the procedure by 8, 12, 24, 48 hours was measured using the Visual Analogue Scale (VAS). Secondary outcome that was follow up visits to determine the intervention results by time on pain using the (VAS) and to evaluate its effect clinically and radiographically after 1month, 3months and 6months. Results: The study resulted in after 8 hours,Group B showed higher prevalence of no pain, mild pain as well as severe pain. Group A showed higher prevalence of moderate pain.After12 hours,Group B showed higher prevalence of no pain and severe pain. Group A showed higher prevalence of mild pain. After 24 hours, Group B showed higher prevalence of no pain than Group A, which showed higher prevalence of mild pain. After 48 hours, all cases had no pain. After 1 month, Group B showed higher prevalence of no pain in comparison with Group A, which showed higher prevalence of severe pain as all cases needed root canal treatment.Conclusion: pulpotec is considered successful as an intra-coronal dressing in relieving pain of acute pulpitis with apical periodontitis within 48 hours from the beginning of the procedure and up to 6 months postoperatively. Calcium hydroxide succeeded to relief the pain of acute pulpitis associated with apical periodontitis within the first 48 hours; however it failed to relief the pain over the follow up period.Recommendation: This study limited to pain evaluation over 6 months follow up period after using pulpotec as intracoronal dressing in vital pulp therapy so more experiments upon other clinical and histological effect for longer time with comparison to other treatment modalities and pulpotomy medicaments is recommended.