Rapid Maxillary Expansion and Nocturnal Enuresis in Children and Adolescents: A Systematic Review of Controlled
Khaled Khalaf1, Dina Mansour1, Zain Sawalha1
1Department of Preventive and Restorative Dentistry, University of Sharjah, Sharjah, UAE.
Insights
Rapid palatal expansion (RPE) shows promise for treating childhood nocturnal enuresis when conventional methods fail. Studies indicate a significant reduction in bedwetting episodes and a correlation with increased nasal volume after RPE treatment.
Area of Science:
- Orthodontics
- Pediatric Sleep Medicine
- Urology
Background:
- Nocturnal enuresis affects children and adolescents, often persisting despite conventional treatments.
- Rapid palatal expansion (RPE) is an orthodontic procedure primarily used to widen the palate.
Purpose of the Study:
- To systematically review the effectiveness of RPE in treating nocturnal enuresis in children and adolescents aged 6-18.
- To evaluate RPE as an alternative therapy for treatment-resistant nocturnal enuresis.
Main Methods:
- Systematic review of RCTs and CCTs identified through comprehensive database and manual searches up to June 2020.
- Included studies focused on children and adolescents (6-18 years) with nocturnal enuresis unresponsive to prior treatments.
- Risk of bias was assessed using ROBINS-I for CCTs and RoB 2 for RCTs.
Main Results:
- Four studies (1 RCT, 3 CCTs) met inclusion criteria.
- All studies reported a reduction in nocturnal enuresis frequency, with most showing statistically significant decreases in wet nights.
- Complete dryness rates at 1 year post-RPE ranged from 0%-60%, and a significant correlation was found between improved enuresis and increased nasal volume.
Conclusions:
- Rapid palatal expansion may serve as a viable alternative treatment for nocturnal enuresis in cases where other methods have been unsuccessful.
- The prognosis for RPE in treating nocturnal enuresis should be considered guarded, especially when conventional therapies fail.
Objectives:
To evaluate the effectiveness of rapid palatal expansion in the treatment of nocturnal enuresis among 6-18-year-old children and adolescents.
Methods:
Comprehensive searches were carried out in 6 electronic databases (EBSCO, ProQuest, Clinical Key, Science Direct, SCOPUS, and OVID) and supplemented by additional manual searches in 4 orthodontic journals until June 2020. Randomized controlled clinical trials (RCTs) and controlled clinical trials (CCTs) of children and adolescents aged 6-18 years old of both genders who underwent rapid palatal expansion and were considered unresponsive to previous conventional nocturnal enuresis treatment were included in this review. Risk of bias of individual trials was assessed using the Risk of Bias in Non-randomized Studies of Interventions (ROBINS-I) assessment tool for CCTs and the revised Cochrane Risk-of-Bias tool for RCTs (RoB 2).
Results:
Four studies met all inclusion criteria and were finally included in this systematic review, of which one was an RCT and three were CCTs. Reduction in nocturnal enuresis frequency was reported in all included studies with varying rates and methods of reporting, but most studies reported a statistically significant reduction in the number of wet nights per week. The average range of becoming completely dry 1 year after treatment with an RME was 0%-60%. Also, there was a statistically significant correlation between an improvement in bedwetting and an increase in nasal volume after the use of RME.
Conclusion:
A rapid palatal expansion device may be considered as an alternative treatment option of the nocturnal enuresis condition with guarded prognosis when other treatment modalities have failed.
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