Response to Pulp Vitality Tests in Teeth Submitted to Orthodontic Movement, Adjacent to the Cleft Area

Abstract

Objective: To evaluate the pulp vitality in teeth adjacent to the cleft area submitted to orthodontic movement into the alveolar graft area in individuals with complete unilateral cleft lip and palate (CUCLP). Design: Cold sensitivity, vertical, and horizontal percussion tests were conducted on the teeth adjacent to the cleft and the contralateral teeth. Setting: Endodontics Sector in the Hospital for Rehabilitation of Craniofacial Anomalies, University of São Paulo (HRAC/USP). Patients: One hundred patients with CUCLP and hypodontia of the upper lateral incisor in orthodontic movement and after successful alveolar bone graft in the cleft area. Main Outcome Measures: The cleft study group (SG) was composed of 200 teeth, adjacent to the cleft area. The control group (CG) consisted of 200 contralateral teeth. Statistical analysis was performed using the chi-square test for comparisons between groups ( P < .05). Results: In the SG, 82.0% of teeth presented positive response to the cold sensitivity testing, 13.5% had negative response, and 4.5% had marked response, with statistically significant difference in relation to the CG. The vertical and horizontal percussion tests on teeth in the SG revealed the same results, in which 95.0% presented negative response and 5.0% responded positively, without significant difference compared to teeth in the CG, for both tests. Conclusions: Teeth adjacent to the cleft area presented changes in the physiological conditions of the pulp, which were observed by reduction of positive response to the cold sensitivity testing or presence of pulp hypersensitivity in cases of marked response.

Endodontic Considerations in Contemporary Orthodontic Practice- A Review

“…Though very few studies suggested that heavy forces can lead to loss of tooth vitality but there are not enough evidences to support this fact 11 . Most of the other studies have shown that there might be changes in pulpal blood flow, hyperemia or oxygen saturation but no long term effect on pulp vitality 9,[12][13][14] The study has shown that even with heavy intrusive force there is no change in vitality of dental pulp in normal teeth but teeth having history of previous trauma are more susceptible to pulpal necrosis 15 . Traumatized incisors, especially maxillary lateral incisors have high chance of pulpal necrosis during orthodontic intrusion than normal teeth 15 .…”

Does the rehabilitation treatment predispose the patient with cleft to endodontic treatment?

“…Depending on the extent, the bone defect can be seen as a radiolucent area surrounding the periapical portion of teeth adjacent to the cleft. This evidences the importance of performing adequate anamnesis, physical and complementary exams for an accurate diagnosis 2,3 .…”