Effects of Maxillary Protraction Techniques on Maxillofacial, Dental, and Soft Tissue Outcomes in Patients With Non-Syndromic Unilateral Cleft Lip and Palate: A Systematic Review and Meta-Analysis.

Objectives: To perform a quantitative assessment and best-evidence synthesis of maxillary protraction techniques for unilateral cleft lip, alveolus, and palate (UCLAP), incorporating all available studies regardless of methodological quality.

Materials and methods: Studies on growing non-syndromic UCLAP patients requiring maxillary protraction-against treated or untreated comparator groups-were identified across databases including PubMed, Embase, Scopus, Web of Science, EBSCOhost, Ovid MEDLINE, LILACS, Cochrane Library, and grey literature until April 23, 2025. Risk of bias for included studies was assessed using the Methodological Index for Non-randomised Studies and the Cochrane Risk of Bias tool. A random effects model was applied using RevMan for quantitative analysis.

Results: The search identified 1,892 articles, of which 36 met the inclusion criteria, categorised under four protraction methods: bone-anchored, skeletally-anchored facemask, facemask (FM) only, and intraoral springs, with or without expansion. Quantitative synthesis was feasible only for the FM group. Compared to no-protraction UCLAP (NP-UCLAP), Protraction group (P-UCLAP) showed a significant short-term increase in ANB angle (MD = 4.34; 95% CI: 3.65-5.03; p < 0.00001; I² = 73%). When compared to treated non-cleft individuals, FM therapy also showed a significant ANB increase (MD = 0.86; 95% CI: 0.42-1.29; p = 0.0001; χ² = 4.65; I² = 35%).

Conclusion: FM therapy shows short-term benefits from low-quality studies for UCLAP maxillofacial growth and future studies might not be necessary as supported by sequential analysis. Evidence for skeletally anchored methods and addition of expansion to any protraction method remains weak and rigorous, long-term studies are needed.