Orthognathic surgery and its relationship on pulpal blood flow and pulp sensibility: A systematic review and meta-analysis.

Abstract

Introduction: This systematic review and meta-analysis aimed to evaluate the impact of orthognathic surgery (OS) on pulp sensibility (PS) and pulpal blood flow (PBF).

Methods: A comprehensive literature search was conducted across multiple databases, including PubMed, Embase, Cochrane, Web of Science, Scopus, and ScienceDirect. A comprehensive search was conducted in multiple databases covering studies published up to August 2024 to include both peer-reviewed studies and gray literature. to include both peer-reviewed studies and gray literature. The included studies reported on pulp blood flow and sensitivity following orthognathic surgery, with preoperative values used as control measurements. The quality of the included studies was assessed using the ROBINS-I tool for non-randomized studies, and the GRADE tool was applied to evaluate the certainty of the evidence. A random-effects model meta-analysis was conducted to account for variability across studies.

Results: Fourteen studies were included, with an overall "Moderate" quality assessed by ROBINS-I. The GRADE assessment indicated that the certainty of evidence was low overall due to serious concerns regarding the risk of bias and inconsistency. A significant reduction in PBF was observed in the orthognathic surgery group at all time points. The primary analysis at 3 months reported a standard mean difference (SMD) of -2.20 (95% CI: -3.98 to -0.41), with substantial heterogeneity (I² = 91%). Subgroup analysis, excluding studies contributing to heterogeneity, yielded a SMD of -0.59 (95% CI: -1.09 to -0.10), reducing I² to 0%. At 6 months, the SMD was -1.75 (95% CI: -2.96 to -0.54; p < 0.05), with high heterogeneity (I² = 89%). Subgroup analysis reduced heterogeneity to 0%, but the effect size decreased (SMD: -0.50, 95% CI: -0.90 to -0.10; p < 0.05). At 12 months, the pooled SMD was -1.99 (95% CI: -3.30 to -0.67), with moderate heterogeneity (I² = 76%) CONCLUSION: This meta-analysis provides evidence of the impact of OS on PBF and PS. It demonstrates an initial reduction in both parameters, followed by a progressive trend toward recovery. However, BF values remain lower in OS patients compared to controls, and substantial heterogeneity was observed across studies.