Impact of Orthodontic Closure on Pulpal Health of Teeth Adjacent to Orofacial Clefts

BACKGROUND: Orofacial clefts, including cleft lip and/or palate (CLP), are common congenital deformities often associated with various dental anomalies. Orthodontic space closure adjacent to cleft sites is an integral part of rehabilitative care, but its impact on pulpal health remains uncertain. This systematic review aimed to assess the effects of orthodontic movement on the vitality of teeth adjacent to cleft areas in CLP patients. MATERIALS AND METHODS: This review followed PRISMA guidelines and was registered in PROSPERO (CRD420251040142). A systematic search was performed in PubMed, Google Scholar, Scopus, and LILACS using defined keywords. Inclusion criteria focused on human studies evaluating pulpal health of teeth adjacent to clefts undergoing orthodontic space closure. The included articles were assessed on their demographic data, type of tooth involved both on cleft and non-cleft sides along with their vitality status and interventions done to the non-vital teeth. Risk of bias was assessed using ROB 2.0 and Modified REMARK tools. Meta-analysis was conducted using JASP software. RESULTS: The review included six studies with unilateral cleft patients as a prevalent group. Of the six studies, three were rated as having low risk of bias, while two were labelled questionable and one as high risk. The results demonstrated a higher incidence of pulpal necrosis (12% increased risk) on cleft-side teeth post-orthodontic movement with statistically significant differences (p<0.0001). Significant heterogeneity and variability in diagnostic methods were observed, with publication bias evident. CONCLUSION: This meticulous review of articles concluded that the cleft lip and palate pose a greater risk of vitality alteration in teeth close to the bone defect area. The use of various vitality testing measures throughout the literature helped achieve rehabilitation treatment as early to restore quality of life.