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Rapid Palatal Expansion to Treat Nocturnal Enuretic Children: a Systematic Review and Meta-Analysis
Karim Poorsattar-Bejeh Mir1, Arash Poorsattar-Bejeh Mir2, Morvarid Poorsattar-Bejeh Mir3
1Dept. of Pediatrics, Amir Mazandarani General Hospital, Mazandaran, Iran.
Insights
Rapid palatal expansion (RPE) shows promise for treating refractory nocturnal enuresis in children, achieving a 31% cure rate. This orthodontic intervention may be a viable option when other treatments fail.
Area of Science:
- Orthodontics
- Pediatrics
- Sleep Medicine
Background:
- Refractory nocturnal enuresis significantly impacts children's psychosocial well-being.
- Spontaneous cure rates for nocturnal enuresis are low, around 15% annually.
Purpose of the Study:
- To evaluate the efficacy of rapid palatal expansion (RPE) in treating childhood nocturnal enuresis.
- To synthesize evidence from patient-level data for a meta-analysis.
Main Methods:
- A comprehensive literature search was conducted across multiple electronic databases (PubMed, SCOPUS, Cochrane, CINAHL, EBSCO) up to January 2014.
- Included studies involved children aged six years or older with nocturnal enuresis who had undergone RPE after prior pharmacotherapy attempts.
- Six non-randomized clinical trials, with five lacking control groups, were analyzed, involving 80 children.
Main Results:
- The median time to achieve complete dryness was 2.87 months.
- The one-year cure rate for nocturnal enuresis following RPE was 31%.
- Posterior crossbite was associated with a decreased chance of improvement (RR: 0.31), while upper respiratory obstruction signs increased the likelihood (RR: 5.1).
Conclusions:
- Rapid palatal expansion is a promising treatment for refractory nocturnal enuresis, offering a higher cure rate than spontaneous remission.
- RPE can be considered when conventional treatments have been unsuccessful.
- Further high-quality randomized controlled trials are needed to strengthen the evidence (Level of evidence: C).
Statement Of The Problem:
Refractory nocturnal enuresis possesses a heavy psychosocial burden for the affected child. Only a 15% spontaneous annual cure rate is reported.
Purpose:
This patient-level meta-analysis aimed to evaluate the efficacy of rapid palatal expansion to treat nocturnal enuresis among children.
Materials And Method:
A sensitive search of electronic databases of PubMed (since 1966), SCOPUS (containing EMBASE, since 1980), Cochrane Central Register of Controlled Trials, CINAHL and EBSCO till Jan 2014 was performed. A set of regular terms was used for searching in data banks except for PubMed, for which medical subject headings (MeSH) keywords were used. Children aged at least six years old at the time of recruitment of either gender who underwent rapid palatal expansion and had attempted any type of pharmacotherapy prior to orthodontic intervention were included.
Results:
Six non-randomized clinical trials were found relevant, of which five studies had no control group. Eighty children were investigated with the mean age of 118 (28.12) months ranged from 74 to 185 months. The median time to become completely dry was 2.87 months [confidence interval (CI) 95% 2.07-2.93 months]. After one year, the average rate of becoming complete dry was 31%. The presence of posterior cross bite [relative risk (RR): 0.31, CI 95%: 0.12-0.79] and signs of upper respiratory obstruction during sleep (RR: 5.1, CI 95%: 1.44-18.04) significantly decreased and increased the chance of improvement, respectively. Meanwhile, the other predictors did not significantly predict the outcome after simultaneous adjustment in Cox regression model.
Conclusion:
Rapid palatal expansion may be considered when other treatment modalities have failed. The 31% rate of cure is promising when compared to the spontaneous cure rate. Though, high-level evidence from the rigorous randomized controlled trials is scarce (Level of evidence: C).
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