Objective: To evaluate the success rate of a calcium hydroxide-based direct capping agent in permanent teeth. Method and Materials: A total of 1,075 permanent teeth were treated in this study. All patients received direct pulp capping with a calcium hydroxide-based agent. Inclusion criteria were teeth with healthy pulps, pulps with signs of reversible pulpitis, and a pulp chamber roof opening smaller than 2 mm2. Pulps with severe degenerative processes or necrosis were excluded. After direct capping, all teeth were definitively restored with amalgam, composite, glass-ionomer cement, or other dental materials. The teeth were observed up to 9 years with a first visit after 3 months followed by an annual routine visit. Results: The success rate of direct capping was 80.1% after 1 year, 68.0% after 5 years, and 58.7% after 9 years. Substantial differences were found regarding the number of tooth surfaces affected by the causal event (P = .0005). The subsequent definitive restorations also significantly influenced the survival rate (P = .0035). Conclusion: Direct pulp capping with calcium hydroxide is a successful therapy when the respective indications and restorative materials are employed. Keywords: calcium hydroxide, clinically healthy pulp, definitive restoration, direct pulp capping, retrospective study, survival rate