Veterinary Vertex
Veterinary Vertex is a weekly podcast that takes you behind the scenes of the clinical and research discoveries published in the Journal of the American Veterinary Medical Association (JAVMA) and the American Journal of Veterinary Research (AJVR). Tune in to learn about cutting-edge veterinary research and gain in-depth insights you won’t find anywhere else. Come away with knowledge you can put to use in your own practice – along with a healthy dose of inspiration to remind you what you love about veterinary medicine.
Veterinary Vertex
What Every Vet Should Know About Vital Pulp Therapy—and Why Precision Matters
A fractured canine tooth tests more than a dog’s bite—it tests our choices as clinicians. We sat down with researchers Ethan Elazegui and Dr. Elias Wolfs to reexamine vital pulp therapy with new data, honest surprises, and practical guidance you can use on your next dentistry day. The conversation starts with what holds true: an ~80% success rate keeps vital pulp therapy squarely in the toolkit as a tooth-sparing option when pulp exposure is recent and the tissue is viable. Then we challenge a common belief: younger dogs didn’t show a significant edge in outcomes, pushing us to prioritize indications and technique over age alone.
We break down what most affects success, and one factor stands out—pulp dressing extrusion. Precision during placement isn’t a nicety; it’s the difference between healing and failure. We also talk timing, including a small-sample quirk that reminds us to interpret data with care. From there, we explore material science: MTA’s respected performance versus biodentine’s faster set, strong biocompatibility, and reduced discoloration risk. Human literature suggests comparable success and better cementum repair for biodentine, a promising path for veterinary endodontics as adoption grows.
Beyond procedures and products, we highlight the power of mentorship and student peer review to raise research quality—and why that matters for everyday clinical decisions. We even look ahead to AI-driven radiograph interpretation, where large, annotated datasets could help flag subtle endodontic and periodontal changes and support more consistent decision-making in general practice.
You’ll leave with clear steps for case selection, referral thresholds, and owner communication about follow-ups—because even good cases need rechecks to catch the 1-in-5 that fail months or years later. If you care about predictable outcomes, better materials, and sharper imaging insights, this conversation is for you. Enjoy the episode, share it with a colleague who does dentistry, and if it helped your practice, subscribe and leave a quick review to help others find the show.
JAVMA article: https://doi.org/10.2460/javma.25.04.0224
INTERESTED IN SUBMITTING YOUR MANUSCRIPT TO JAVMA ® OR AJVR ® ?
JAVMA ® : https://avma.org/JAVMAAuthors
AJVR ® : https://avma.org/AJVRAuthors
FOLLOW US:
JAVMA ® :
Facebook: Journal of the American Veterinary Medical Association - JAVMA | Facebook
Instagram: JAVMA (@avma_javma) • Instagram photos and videos
Twitter: JAVMA (@AVMAJAVMA) / Twitter
AJVR ® :
Facebook: American Journal of Veterinary Research - AJVR | Facebook
Instagram: AJVR (@ajvroa) • Instagram photos and videos
Twitter: AJVR (@AJVROA) / Twitter
JAVMA ® and AJVR ® LinkedIn: https://linkedin.com/company/avma-journals
From the makers of FET recommended Green East Dental Fruits, comes an easy way to support your dog's wellness. Green East Smartest Dentals Dry Food delivers complete balanced nutritionists with science-backed recipes. Green East Supplement, developed by a team of PhD animal nutritionists, offers options to help support healthy joints, digestion, and more. Whether it's mealtime or mobility support, GreenEats helps you care for your dog from the inside out. Learn more at greeneats.com.
SPEAKER_02:This is Veterinary Vertex, a podcast in the ABMA Journals. In this episode, we chat about the success rate of vital pulp therapy and factors influencing outcomes with current standards with our guests, Ethan Alizeke and Elias Wolf.
SPEAKER_01:Welcome, listeners. I'm Editor-in-Chief Lisa Fortier, and I'm joined by Associate Editor Sarah Wright. Ethan and Ilias, thank you for taking time out of your busy schedule today to be with us.
SPEAKER_04:Thank you for having us. Yeah, thank you for having us. We really appreciate the invitation.
SPEAKER_02:Of course. All right, let's dive right in. So, Ilias, your JAFA article reassesses the success rate of vital pulp therapy in dogs and evaluates the impact of patient age and pulp exposure duration on outcomes. Please share with our listeners the background on this article.
SPEAKER_04:Yeah, so um the literature on vital pulp therapy um was um quote unquote a little bit outdated. It has been over two decades um since the outcome had been evaluated. Um so we thought it was um the time had come to um potentially reevaluate the success rate. And then we also had um an extra hypothesis that had not been previously investigated, and we suspected that um younger dogs uh potentially had a better outcome because their apices or the tooth apex is still open, so that has inherently a better blood supply and better regenerative potential. Um, so we wanted to look at that data set as well, um, versus the tooth apex of older dogs that is closed. We we thought or hypothesized that um they could potentially have a worse outcome.
SPEAKER_02:It's always great to see dentistry manuscripts because like everyone needs dental care. And I feel like we don't we don't see that many of them, honestly. So it's really nice to see them in the journal. So thank you for contributing this work.
SPEAKER_04:Yeah, absolutely.
SPEAKER_02:And Ethan, what are the important take-home messages from this JAGMA article?
SPEAKER_03:Yeah, so there's a few. I think one of the biggest takeaways um is that vital pulp therapy remains a pretty viable alternative to other endodontic therapies such as root canal, um, especially when managing pulp exposure. Uh, we found that VitalPulp has about an 80% success rate, which aligns pretty well with previous studies. Um As uh I said, we hypothesized that younger dogs would have higher vitapult therapy success rates when compared to dogs. However, we actually didn't find uh any significant association between patient age and outcome. Uh lastly, um, deep pulp dressing intrusion um significantly increases odds of vitapult therapy failure. So it's pretty um important when applying the dressing to really carefully and precisely do that in order to decrease any likelihood of failure in the future.
SPEAKER_01:Great take homes. Uh Ilias, you started out by saying, you know, this isn't new, uh, but and the literature is a little bit outdated. What really sparked your interest to look at this again? Was it a case or an astute student or somebody asking a question?
SPEAKER_04:Um, yeah, that's a good question. Um, so first of all, um Eton was a uh or still is a very keen uh student who wanted to do a research project with us. So we kicked around with a few ideas, um, and we thought that the time had come to um look again at vital pulp therapy, and then with the extra hypothesis of um we suspected that younger dogs would have a better outcome. Unfortunately, it turned out for our study that that was not necessarily the case. Um, and doing a retrospective study, uh looking at radiographs and at the uh medical records is a relatively low-hanging fruit. So we thought that would be a good project to do with uh Ethan, um, who did the lion's share uh of all the work from data collection to scientific manuscript writing. Um, so that was a very nice and good experience overall with him.
SPEAKER_01:I'm not surprised. That was kind of a gimme sort of question. I know you know, Ilias, but for listeners, Ethan is actually one of our student reviewers for Jabma and AJVR. To our knowledge, we're the only, at least veterinary journal, if not journals in general, that take on student reviewers and actually teach them how to review articles for scientific content, how to provide constructive comments, and we give them feedback. It's actually a fantastic program. Uh and Ethan, thanks for being one of our student reviewers.
SPEAKER_04:Sorry. Um, I just want to chime in briefly that um as a junior faculty, it's also like my first time taking on a student under my wings um and coaching them in this bad process. And I have to say that working with Ethan has been an absolute breeze, and I couldn't have hoped or wished for a better student to work with. So it's uh has been a really good experience overall. Fantastic. I really like that you guys are also um getting students involved from um early on in their career. I feel like that earlier on you can coach them and support them um sets them up for success later on.
SPEAKER_01:Go ahead, Ethan. Tell us about the student reviewer pro experience.
SPEAKER_03:Yeah, I mean, it's been a really great experience. Um Actostall and everyone has really sort of really taught me a better way of sort of approaching and evaluating scientific literature. And I feel like I really take a lot of I think it's also really positively impacted, I guess, my research and sort of how I carried out and approached um writing and data analysis and the sorts.
SPEAKER_01:Excellent. That's the that's the goal. So it's working. Uh well, I have you, Ethan. You uh had a little conversation with Sarah earlier about where some of the take-home messages are, but every time we do an experiment, things surprise us, which then lead to other hypotheses and other studies. What surprised you from the work you did for this article?
SPEAKER_03:Yeah, I think you know, in our study, we actually found that um dogs who received vital pulp therapy more than 24 hours following pulp exposure actually had a greater time to failure, or in other words, it took longer for them to fail when compared to dogs that received vital pulp within 24 hours. Now, this isn't necessarily what we would have expected, as previous studies have shown that basically the earlier vital pulp therapy is performed following exposure, the more likely it is to succeed. Conversely, if it the longer it takes for vitapult therapy to be performed, the higher likelihood of uh it failing. Um, we we have attributed this to um basically our low sample size. We only had one dog in that category.
SPEAKER_02:So, Ethan, what are the next steps for future research in vital pulp therapy?
SPEAKER_03:Yeah, so um mineral trioxide aggregate or MTA, it's pretty widely regarded as the sort of gold standard for pulp dressing material in both human and veterinary medicine. However, there is a new promising alternative known as biodentine, um, and it has some pretty favorable properties, such as a faster setting time, higher cytocompatibility, meaning it's just sort of safer for cells, and also lacks this sort of compound called bismuth oxide, which sort of delays setting time and causes discoloration. Um, and so previous human studies have shown that biodentine and MPA achieve pretty comparable success rates in pulp capping and pulpotomy procedures. Um, notably, biodentine has a pretty superior, I guess, cementum repair as well as um reduced extrusion into surrounding soft tissues. And so that we think that this could really promote better healing outcomes. And so um it's not biodentine's not pretty commonly used in vetmed right now, but it's really a very attractive candidate for future use in veterinary pulp therapy.
SPEAKER_02:Very cool. Sounds like another great project for you and Elias working on together. So, Elias, AI is everywhere. We're seeing it also pop up in some facets too of veterinary medicine. Do you see a role for AI in this particular area of research?
SPEAKER_04:Um, yeah, that is a good question. And I think AI is something that, as we all know, has been rapidly evolving. Um in the long run, I do believe that there will be a place for it. Um, maybe in taking a bit more of a step back in the broader term of AI. I do think that with machine learning, um, eventually we could train the computer to assess dental radiographs, which would probably pick up small details better than humans in terms of periodontal as well as endodontal disease that could probably um help general practitioners as well as um residents, boarded dentists, um, students. Um, but um we need to be careful. Um, and I think we would need hundreds, maybe thousands of cases um to be put in into the computer. Um, I don't think we're there yet, but in the long run, I do see that I would not be surprised if someone came up with a software that would be commercially available to help guide people with um clinical decision making.
SPEAKER_01:Yeah, dental RADs can be pretty difficult to interpret. I think we just skip them now and go straight to CT.
SPEAKER_04:Right.
SPEAKER_01:Ethan, uh, as a four-stage veterinary school, and as we said earlier, a student reviewer for Jabma and AJVR, how did all your combined training or previous work help prepare you to write this article? And not just write the article. What words of wisdom do you have for people like how to identify a topic and really get it done while you're in veterinary school?
SPEAKER_03:Yeah, that's a good question. I think for me, uh, you know, my introduction to research really began in my undergrad. Um, I think that really laid the basic foundations. I guess, you know, in understanding uh general scientific method, hypothesis testing, and manuscript writing. Um in vet school, I'm you know, pursuing a DVM and Wisconsin actually offers a clinician researcher emphasis. And so I'm pursuing that, and it's really helped me to, I guess, integrate uh research into clinical practice and how to better design and carry out uh projects. And like you said, you know, I I do participate in the Jabma AJVR student peer review program, and I also participated in Wisconsin's Summer Scholars Program. And so they've really helped me and provide me with the tools and really the frameworks, uh, I guess approach research in a more structured and confident manner. So um yeah, I think together those experiences have really, you know, equipped me with you know the technical knowledge and the you know the skills that were pretty important in helping develop this project.
SPEAKER_01:Just expand a little bit on how what advice you would give to other veterinary students that are looking to get involved in research. How do you get it all done?
SPEAKER_03:Oh, yeah, I it's it's it can be challenging, you know, or a little bit overwhelming with you know veterinary schedules and classes. Um for me, I I early on identified dentistry as a as a you know potential topic or a future career path that I wanted to go into, and I really wanted to pursue further research. So I definitely reached out um early on uh to see if there were any small projects that I could sort of be a part of. And um thankfully you know, Elias had one for me and I'm really grateful for that. So I encourage any sort of interest just to reach out there, step outside of your comfort zone a little bit.
SPEAKER_02:I did my first project when I was a third-year veterinary student, and I remember it was hard juggling classwork and manuscript writing, and mine was like a prospective study, so organizing the travel and working with all the different teams. Yeah, it's it was a lot, but kudos to you too, Ethan, for crossing the finish line with this manuscript.
SPEAKER_04:I just wanted to add to that that um it feels like yesterday that Ethan knocked on my door, and next week he's actually giving a poster session at the American Veterinary Dental Forum uh with his paper that is published. So that is quite an achievement.
SPEAKER_02:Amazing. Congratulations, Ethan. That's wonderful.
SPEAKER_04:Thank you.
SPEAKER_02:Okay, we want photos too, by the way. So you can put them on social media to show off how awesome our student reviewers are. So this next set of questions is going to be really important for our listeners. You shared really great information today about vital pulp therapy. So we want to share with our listeners now what's the one thing that's really gonna change the way that they practice. So, Elias, what is one piece of information the veterinarian should know about the success rate of vital pulp therapy in dogs?
SPEAKER_04:Um, it remains a viable treatment uh for relatively acutely fractured teeth for which referral to a veterinist is recommended.
SPEAKER_02:Very well said. And then Ethan, on the other side of the relationship, what's one thing clients should know about this topic?
SPEAKER_03:Yeah, I think one important thing is that vital pulp therapy isn't necessarily a one-and-done treatment. At least in our study, we found that one in five teeth may eventually fail, sometimes months or even years after the initial procedure. So that's why follow-up exams are pretty important. I think it's recommended that rechecks occur every six months for the first year or two and then annually thereafter, of course, sooner if there's any concerns. And so really keeping up with those visits helps to catch problems early and gives um your pet the best chance the best chance for long-term success.
SPEAKER_01:One in five doesn't seem to be that bad from what I remember in large animal and horse teeth at least. I think it's more like 50% end up with some other thing that goes wrong. Thank you guys again. Uh always, always fun to learn more things about dentistry, which I still don't think we learn enough of in veterinary school. As we wind down, we'd like to ask just a little bit of a fun question. So, Elias, if you could have a superpower, what would it be and why?
SPEAKER_04:Yeah, um, another great question. I had to think about it for a second, and eventually I thought about it, would be really nice to be able to teleport yourself. Uh, because one of the things that lately has been bugging me is the increasingly expensive cost of flying to conferences as well as courses or areas where you can give a talk or um an a CE event. Um, and on top of that, with missed connections, um, I do believe it would be really nice to just be able to move from point A to point B in um in a blink of a second. I agree.
SPEAKER_01:Yeah, and then think of how much more time you'd have for fun.
SPEAKER_04:Exactly.
SPEAKER_01:All that commuting time, all that stuff, that that would be an amazing, not just cost savings, but time.
SPEAKER_04:Yep, cost savings and time. I love that.
SPEAKER_01:Ethan, uh Sarah and I have a bit of a hypothesis for the the answer to the next this next question. So I think I know what your answer will be. But uh when you complete a puzzle, do you begin with the middle interior and complete some form of theme, or do you do the exterior border pieces first?
SPEAKER_03:Uh I I tend to start with the border pieces and I try to work all the way around. But you know, as I do go, I if I come across any like middle pieces that sort of seem to fit like a pattern or an area, I tend to sort of roughly place them where they might belong. But yeah, that border definitely gives me a better framework to work with and makes it a little bit more manageable.
SPEAKER_01:Doesn't surprise me, but I would hypothesize that was your answer. And uh our uh our um assessment so far is that people that tend to do surgery are the exterior border pieces and inter purely internists or educational folks are more the ones that do the uh middle interior. Whoever knew you could even start it. One of my daughters does the middle interior. Dives me crazy. I'm like, well, you don't have the you don't have the framework yet.
SPEAKER_04:Yeah, when I read the question, I had also no idea that people would do the interior first. I thought that the framework was something that um was something everyone did.
SPEAKER_02:No, it's a fun one. We I say it's every episode, but really do gotta compile those answers. So I think it would be interesting. But thank you so much, Ethan and Elias, for being here today and for also sharing your nephew streaming and the script too with Jabma.
SPEAKER_04:Thank you so much. Yeah, thank you for having us.
SPEAKER_02:And to our listeners, you can read Ethan and Elias' article in Jabma. I'm Sarah Wright with Lisa Fordier. Be on the lookout for next week's episode. And don't forget to leave us a rating and review on Apple Podcasts or whatever platform you listen to.
