Rapid Maxillary Expansion and Nocturnal Enuresis in Children and Adolescents: A Systematic Review of Controlled Clinical Trials
Table 1
Summary data of the included studies.
Author, year of study
Study type
Participants
Inclusion and exclusion criteria
Intervention/control
Amount of expansion
Follow-up periods
Findings of the study
Neveus et al., 2014 and Bazargani et al., 2016 (one study published as two separate articles)
Nonrandomized controlled trail
(i) 34 (29 M, 5 F), one dropped out
(i) Inclusion criteria: children did not respond to conventional treatments
RME appliance activated for all patients/RME appliance was left passive for the initial 4 weeks for all patients
0.5 mm daily (0.25 mm morning, 0.25 mm night)
(i) Baseline (before treatment)
(i) The number of wet nights/week on the 4 follow-up periods was 5.48 ± 1.48, 5.12 ± 1.73, 3.09 ± 2.49, and 2.63 ± 2.81; < 0.001
(ii) Age: 8–15 years
(ii) Exclusion criteria: known general medical conditions or medications that are linked to NE
(ii) With the orthodontic appliance in situ
(ii) After RME the number of responders and intermediate responders was 16/33 (48.5%), and the number of nonresponders was 17/33 (51.5%)
(iii) 6 months (after completion of expansion)
(iii) The long-term cure rate after 1 year was 18/30 (60%), whereas 12/30 (40%) had no long-term response
(iv) 1 year post treatment
(iv) Nonresponders had more frequent enuresis (6.29 ± 1.31 versus 4.63 ± 1.15 wet nights/week; = 0.001)
Al-Taai et al., 2015
Nonrandomized controlled trial
(i) 19 (1 M, 18 F)
(i) Inclusion criteria: healthy children with monosymptomatic primary NE (MPNE) treated with Minirin without long-term improvement
RME appliance activated for all patients/RME appliance was left passive for the initial 30 days for 7 patients
0.45 mm per day
(i) 2–3 months after RME
(i) The mean value of wetting per night before expansion = 2.21
(ii) Age: 6–15 years
(ii) Exclusion criteria: dryness >6 months, known general medical conditions or medications that are linked to NE
(ii) 1 year after RME
(ii) The mean value of wetting per night 2–3 months after RME = 0.42
(iii) 3 years after RME
(iii) 30 days after RME expansion, 6 out of 12 children demonstrated complete dryness, and the remaining demonstrated an improvement of NE
(iv) No significant impact on NE ( > .05) was found in the control group (7 patients) 30 days after the use of a passive RME device
(v) After 3 years, all patients reported complete dryness
Hyla-Klekot et al., 2015
Nonrandomized control trial
(i) 41 in total
(i) Inclusion criteria: present NE, lack of disease in the kidneys and urinary tract system
RME activated (16)/No RME (25)
Total of 6.5 mm
(i) Every month during the first 12 months
(i) 10/16 children in the intervention group did not wet the bed at all after 3 months and this was maintained 3 years later (8/16 children remained dry)
(ii) Age: 6–18 years
(ii) Exclusion criteria: active dental caries, bad oral hygiene, inadequate number of teeth for fitting the appliance, and lack of cooperation with orthodontic treatment
(ii) 3 years
(ii) After 3 years, 50% of the children in the intervention group were completely dry compared with only 32% in the control group
(iii) 16 experimental (9 M, 7 F)
(iii) After 3 years, there was 4.5 times increase in the reduction of NE in the experimental group compared with the control group
(iv) 25 control (15 M, 10 F)
Jönson Ring et al., 2019
Randomized clinical trail
(i) In total 38, 2 dropped out from the placebo group, age: 10.2 ± 1.8
(i) Inclusion criteria: primary NE with at least 7 wet nights fortnightly and nonresponders to first-line treatment
RME appliance activated for 2 weeks/RME appliance was left passive for the 2 weeks
0.5 mm per day
(i) Baseline (T0)
(i) From T0 to T1, the experimental group demonstrated a significant reduction of wet nights (mean difference = −2.2) and the placebo group demonstrated no significant reduction of wet nights, mean difference = −0.6). The difference between the 2 groups was not statistically significant
(ii) Intervention group 18 (18 M), age (10.3 ± 1.8)
(ii) Exclusion criteria: known general medical conditions or medications that are linked to NE
(ii) 2 weeks (T1)
(ii) The mean reduction of wet nights for the whole group 6 months after expansion was significant (mean difference = −3.2)
(iii) Placebo group 20 (17 M, 3 F), age (10.2 ± 1.8)
(iii) 6 months (T3)
(iii) 11 patients (35%) had a reduction in the frequency of NE by >50%
(iv) At 6 months, the number of full, intermediate, and nonresponders was 1, 10, and 20, respectively
(v) A wide maxilla and great voided volumes at baseline may be associated with a reduced frequency of enuresis
