Review Article

Year : 2026 | Volume : 17 | Issue : 1 | Page : 1-11

Dental Pulp Response and Tooth Discoloration after Orthognathic Procedures: A Systematic Review & Meta-Analysis

Haytham Jaha1 , Ibraheem K Bamaga2

1-Associate Professor and Consultant in Endodontics, Endodontic Division, Department of Restorative Dentistry, Faculty of Dental Medicine, 2-Associate Professor and Consultant in Orthodontics, Department of Basic and Clinical Oral Science, Faculty of Dental Medicine, Umm AI-Qura University, Makkah, Saudi Arabia

Address for Correspondence:

Dr. Haytham Jaha

Associate Professor and Consultant in Endodontics,

Endodontic Division, Department of Restorative Dentistry,

Faculty of Dental Medicine, Umm Al-Qura University,

Makkah, Saudi Arabia

Email: haythamjaha@gmail.com

ABSTRACT     

Background: Orthognathic surgery, including procedures such as Le Fort I osteotomy and genioplasty, is performed to correct craniofacial discrepancies and malocclusions. However, these procedures may lead to complications such as changes in dental pulp response and tooth discoloration.

Objective: This systematic review aims to evaluate the evidence regarding the dental pulp response and the incidence of discoloration following orthognathic procedures.

Materials & Methods: Relevant studies investigating pulp blood flow, pulp sensitivity, and dental discoloration after orthognathic surgery were reviewed. Observational studies, case reports, and clinical investigations on pulp response and discoloration in patients undergoing procedures such as Le Fort I osteotomy were included.

Results: Pulp blood flow in anterior teeth significantly drops immediately after surgery, often leading to negative pulp sensitivity tests in the first days and weeks post-operatively. Recovery of pulp sensitivity occurs gradually, with some teeth regaining a positive response within three months. Dental discoloration occurs in approximately 3.5-5% of cases after orthognathic procedures, mainly due to vascular impairment or mechanical injury to the apical region. Discoloration may present early, sometimes as a dark pink hue, and is often reversible; however, persistent discoloration combined with loss of pulp sensitivity may indicate pulpal necrosis, warranting root canal therapy and non-vital bleaching as effective management. Patients should be informed of these potential complications preoperatively.

Conclusion: Orthognathic surgery can acutely affect pulp vitality and pose a risk of dental discoloration via vascular or mechanical trauma. Most cases resolve with conservative dental management. Awareness and monitoring are critical for early identification and appropriate treatment to ensure satisfactory esthetic and functional outcomes.

Keywords:Orthognathic surgery; Dental pulp response; Pulp vitality; Pulp sensitivity: Pulp blood flow; Tooth discoloration; Le Fort I osteotomy; Genioplasty

CONFLICT OF INTEREST AND FUNDING

Nil

How to cite this article: Haytham Jaha, Ibraheem K Bamaga. Dental Pulp Response and Tooth Discoloration after Orthognathic Procedures: A Systematic Review & Meta-analysis. Int J Orthod Rehabil 2026; 17 (1): 1-11.

Doi: 10.56501/Intjorthodrehabil.171.ijor0067

Review Article

Year : 2025 | Volume : 16 | Issue : 2 | Page : 28-40

Impact of Orthodontic Closure on Pulpal Health of Teeth Adjacent to Orofacial Clefts: A Systematic Review and Meta-analysis

Ibraheem K Bamaga1, Haytham Jaha2

1-Assistant Professor, Department of Basic and Clinical Oral Science, School of Dental Medicine, Umm AI-Qura University, 2-Assistant Professor and Consultant in Endodontics, Endodontic Division, Restorative Dentistry Department, Faculty of Dental Medicine at Umm Al-Qura University, Makkah, Saudi Arabia.

Address for Correspondence:

Dr. Ibraheem K Bamaga  DDS, MSD, PhD

Assistant Professor, Department of Basic and Clinical Oral Science,

School of Dental Medicine, Umm AI-Qura University,

Makkah, Saudi Arabia. Makkah, Saudi Arabia.

E-mail: Ikbamaga@uqu.edu.sa

ABSTRACT  

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.
KEYWORDS: Orofacial clefts, Pulpal Health, Orthodontic Correction, Tooth Vitality

CONFLICT OF INTEREST

The authors have no conflict of interests to declare.

FUNDING

Nil
How to cite this article: Ibraheem K Bamaga, Haytham Jaha. Impact of Orthodontic Closure on Pulpal Health of Teeth Adjacent to Orofacial Clefts: A Systematic Review and Meta-analysis. Int J Orthod Rehabil 2025; 16 (2): 28-40.