Influence of rapid maxillary expansion on nocturnal enuresis in children: A systematic review

Abstract

Objectives: To evaluate the influence of rapid maxillary expansion (RME) on nocturnal enuresis (NE) in children to discuss whether RME can be indicated as an alternative treatment for NE in those patients. Materials and Methods: An electronic search was performed in the following databases: PubMed/ MEDLINE, Cochrane Library, Scopus, Science Direct, Google Scholar and LILACS. The literature review was blindly performed by two reviewers. References of each selected study were manually searched to identify articles that were not found by the electronic search. Kappa statistics were used to analyze interexaminer agreement after the selection of the articles. After reading the selected full-text articles, the studies that met the inclusion criteria were assessed qualitatively using the Risk Of Bias In Non-randomized Studies of Interventions (ROBINS-I) and the Revised Cochrane risk-of-bias tool for randomized controlled trials-2 (RoB 2). The certainty level of evidence was assessed through the Grading of Recommendations, Assessment, Development and Evaluation tool. Kappa tests were used to analyze the interexaminer concordance level after the quality assessment of the studies. Results: A total of 488 articles were found; however, after applying the inclusion and exclusion criteria, only 8 studies were selected for the systematic review. A low certainty level of evidence suggested that RME seems to promote a variable reduction in frequency or a remission of NE in children in both the short (4, 6, and 8 months) and long term (13, 36, 48, and 120 months). Conclusions: Based on currently available information, RME seems to promote an improvement in NE in children. However, the low quality of the existing evidence weakens the recommendation.