|Year : 2022 | Volume
| Issue : 1 | Page : 22-25
Groper's appliance – For esthetic rehabilitation of anterior missing teeth: Two case reports
Zohra Jabin, Sunil Datt Verma, Nidhi Agarwal, Ashish Anand, Nandita Waikhom
Department of Pediatric Dentistry, Institute of Dental Studies and Technologies, Ghaziabad, Uttar Pradesh, India
|Date of Submission||04-Jul-2021|
|Date of Acceptance||29-Nov-2021|
|Date of Web Publication||30-Apr-2022|
Dr. Sunil Datt Verma
Department of Pediatric Dentistry, Institute of Dental Studies and Technologies, Modinagar, Ghaziabad, Uttar Pradesh
Source of Support: None, Conflict of Interest: None
| Abstract|| |
Rehabilitation of anterior primary teeth is important for the development of phonetics and restoring the natural esthetics of the child. Groper's appliance is a fixed appliance helps in space maintenance, mastication, esthetic appearance, and speech. This article is about two cases where Groper's appliance was given for esthetic rehabilitation.
Keywords: Early childhood caries, esthetics, fixed functional appliance, Groper's appliance
|How to cite this article:|
Jabin Z, Verma SD, Agarwal N, Anand A, Waikhom N. Groper's appliance – For esthetic rehabilitation of anterior missing teeth: Two case reports. J Interdiscip Dentistry 2022;12:22-5
|How to cite this URL:|
Jabin Z, Verma SD, Agarwal N, Anand A, Waikhom N. Groper's appliance – For esthetic rehabilitation of anterior missing teeth: Two case reports. J Interdiscip Dentistry [serial online] 2022 [cited 2023 Mar 23];12:22-5. Available from: https://www.jidonline.com/text.asp?2022/12/1/22/344463
| Clinical Relevance of Interdisciplinary Dentistry|| |
The application of Groper's appliance involves Department of Pediatric and Preventive Dentistry, Esthetic Dentistry and Prosthodontics. It also involves orthodontics because the appliance acts as a functional space maintainer which helps in preventing any malocclusion.
| Introduction|| |
Rehabilitation of esthetics in a young child is challenging. Quiet often, a young child may suffer loss of anterior teeth due to caries or trauma. This premature loss can a have a detrimental effect on the psychological well-being of the child. During early childhood years, anterior teeth play a major role in the development of phonetics. Thus, the replacement of these teeth is essential to restore all their functions. Groper's appliance serves as an appropriate appliance for anterior teeth replacement. The Groper's appliance was first documented by Jasmin and Groper in 1984. The main objective of Groper's appliance was to help in space maintenance, esthetics appearance, and speech. It can be fabricated in different designs depending upon the patient's need. In its earlier design, the teeth were directly attached to metal cleats that were soldered to the palatal wire bar. Similarly, Shanmugaavel et al. created GRASCE appliance using the palatal wire to attach the teeth directly and they replaced molar bands by stainless steel crown.
The present article is aimed at discussing two cases with similar presentation in which prosthetic rehabilitation was done successfully by Groper's appliance.
| Case Reports|| |
Parents of 6-year-old female patient reported to the department of pedodontics and preventive dentistry, Institute of Dental Studies and Technologies, with a chief complaint of decayed teeth with pain for 1 week in the upper front region. No histories of trauma, systemic diseases, or any infections were reported. No abnormality was detected in extraoral features such as general appearance, height, weight, and built. The patient had bilaterally symmetrical facial profile. On intraoral examination, root stumps in relation to 51, 52, 61, 62, and 64 and proximally decayed 74, 75, and 85 were seen [Figure 1]. The parents of the child were very concerned about the esthetic and wanted to restore the anterior teeth.
|Figure 1: (a) Preoperative picture showing root stumps wrt 51, 52, 61 and missing 62. (b) Preoperative frontal facial profile. (c) Fabrication of appliance on maxillary cast. (d) Groper's appliance. (e) After placement of appliance. (f) Postoperative frontal facial profile after placement of Groper's appliance|
Click here to view
All the grossly decayed teeth were planned for extraction and it was carried out under local anesthesia. Groper's appliance was used for the replacement of primary anterior in the maxillary arch. A space maintainer (Band and loop) was indicated in the posterior (64) region for the preservation of space for premolars eruption. The esthetic appliance was designed in such a way that a functional space maintainer was incorporated in the wire framework of Groper's appliance. This appliance was chosen because of its advantages such as preserving an open space and restoration of esthetics and function.
In first appointment
Bands were fabricated on 55 and 65 and impression was made.
Groper's appliance fabrication
Cast was poured with Type III gypsum product-Dental stone. Extending from one band to other band, a stainless steel wire (1.00 mm) framework was made and wire ends were then soldered to the corresponding molar bands of the maxillary teeth. After applying separating media, the cold cure acrylic material being flowed from the palatal area to the labial vestibule and extended to the posterior 64 region over the arch wire. Then, the acrylic teeth were trimmed according to the maxillary primary incisor and teeth were placed over the alveolar crest with the acrylic material. After fabrication of the appliance, it was removed from the cast and ready for an intraoral try-in [Figure 1].
In second appointment
Required adjustment, trimming and polishing was done, and finally, appliance was cemented with luting GIC through the molar band on 55 and 65 [Figure 1]. 75 and 85 were restored with GIC and stainless steel crown placed on 74 by Hall technique. The patient was instructed to maintain proper oral hygiene especially cleaning of acrylic area after every meal. The patient was also instructed to visit after 1 month for follow-up and in case of any breakage of appliance, report immediately. The patient was then followed every month for three successive months and problem of accumulation of food debris and plaque was observed.
A 4-year-old girl reported to Department of Pedodontics and Preventive Dentistry, Institute of Dental Studies and Technologies, with a chief complaint of decayed teeth in the upper front arch. The patient had no medical history and extraoral abnormalities. On examination, it was seen that there were root stumps in relation to 51, 61 grossly decayed 54 and proximally caries in 52, 62, 63, 64, and 84 [Figure 2]. The child was suffering with early childhood caries (ECCs). Parents of the patient were very concerned about esthetics of their child. As the patient required full mouth rehabilitation, thus treatment was planned in a comprehensive manner.
|Figure 2: (a) Preoperative picture showing root stump wrt 51, 61 and proximal caries wrt 52, 54, 62, 64, 84. (b) Extraction done wrt 51, 61 and Composite restoration done wrt 52, 62, 63. (c) Groper's appliance. (d) Intraoral view after placement of Groper's appliance (e) and (f) Frontal view after placement of Groper's appliance|
Click here to view
The root stumps of primary maxillary central incisors, i.e., 51 and 61 were planned for extraction under local anesthesia and to be replaced with the Groper's appliance. 52, 62, and 63 were restored with composite. 64 and 84 were restored with GIC and stainless steel crown placed on 54 by the Hall technique [Figure 2]. The patient was then followed every month for three successive months, and problem of accumulation of food debris and plaque was observed.
| Discussion|| |
ECCs is one of the major oral health problems which affects infants and preschool children in both developed and developing countries. The prevalence of ECC depends on several factors such as socioeconomic status, lifestyle, dietary pattern, and oral hygiene. A review of the literature reports that in most developed countries the prevalence rate of ECC is between 1 and 12%. The national surveys from some countries, such as Greece (36%), Brazil (45.8%), India (51.9%), and Israel (64.7%), showed inconsistent prevalence of ECC. It initiates with white-spot lesion in the upper primary incisor and continues to progressive caries development leading to multiple tooth destruction. Although there is no evidence to prove that early loss of maxillary incisors will definitely hamper the growth or development of maxillary arch, it is important to replace them. Often school-going and young children with the absence of anterior teeth are occasionally bullied or mocked by the other children and may get affected socially.
The decision to replace anterior tooth comprises of several aspects such as child's age and parental desire. Parents should be informed about the importance of these teeth and the impact of their absence. Jabin et al. concluded in their case report that the restoration of anterior esthetics with this appliance gave an essential psychological boost to the child and his parents. Seth et al. and Aniyo et al. also concluded the same in their case reports.
After the eruption of primary canines, loss of primary incisors is not a prime consideration for space loss but other factors indicates their replacement. The loss of few or more anterior teeth may lead to tipping of adjacent teeth, midline deviation, speech problems, over eruption of antagonist teeth, and lingual dysfunction.
The speech disparity is an important consideration for restoring the anterior tooth loss because many sounds are made with the tongue touching the lingual side of the maxillary incisors.
Riekman and Badraway reported in their study that the loss of deciduous anterior teeth before the age of 3 years results in speech problem. On the contrary Gable et al. did not report any long term effect on speech due to early loss of maxillary incisors. In these present case, patient had complains esthetics so this Groper's appliance offers many benefits in term of esthetics, mastication, and speech efficiency. The main demerit of this appliance is the accumulation of food debris and plaque. To avoid this, parent should be instructed to maintain the proper oral hygiene of their child.
| Conclusion|| |
Groper's appliance is easy, simple, and considered as an elective appliance for restoring the anterior esthetics in children. This appliance not only enhancing the esthetics but also acts as functional space maintainer, develops proper speech and thereby boosting confidence in the child during their growing period of life.
Declaration of patient consent
The authors certify that they have obtained all appropriate patient consent forms. In the form, the legal guardian has given his consent for images and other clinical information to be reported in the journal. The guardian understands that names and initials will not be published and due efforts will be made to conceal identity, but anonymity cannot be guaranteed.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
| References|| |
Ripa LW. Nursing caries: A comprehensive review. Pediatr Dent 1988;10:268-82.
Jasmin JR, Groper JN. Fabrication of a more durable fixed anterior esthetic appliance. J Dent Child 1984;51:124-7.
Shanmugaavel AK, Gurunathan D, Sundararajan L. Smile reconstruction for the preschoolers using GRASCE appliance – Two case reports. J Clin Diagn Res 2016;10:ZD19-22.
Livny A, Assali R, Sgan-Cohen HD. Early childhood caries among a Bedouin community residing in the eastern outskirts of Jerusalem. BMC Public Health 2007;7:167.
Congiu G, Campus G, Lugliè PF. Early childhood caries (ECC) prevalence and background factors: A review. Oral Health Prev Dent 2014;12:71-6.
Anil S, Anand PS. Early childhood caries: Prevalence, risk factors, and prevention. Front Pediatr 2017;5:157.
Waggoner WF, Kupietzky A. Anterior esthetic fixed appliances for the preschooler: Considerations and a technique for placement. Pediatr Dent 2001;23:147-50.
Jabin Z, Dudeja P, Dudeja K. Management of bilateral dental agenesis with aesthetic rehabilitation by Groper's appliance – A six-year follow-up. J Clin Diagn Res 2021;14:01-3.
Seth MP, Rani ST, Merum K, Raju S. Fix smile for a while: An esthetic rehabilitation with Groper's appliance – Two case reports. Indian J Dent Adv 2018;10:119-21.
Aniyo R, Kaur G, Neha. Groper's appliance: Fixed appliance for an anterior teeth. Int Res J Med Sci 2019;1:52-4.
Ngan P, Wei SH. Management of space in the primary and mixed dentitions. In: Pediatric Dentistry: Total Patient Care. Philadelphia, PA: Lea and Febiger; 1988. p. 462-70.
Fymbo L. The relation of malocclusion of the teeth to defects of speech. Arch Speech 1936;1:204-16.
Dyson JE. Prosthodontics for children. In: Wei SH, editor. Pediatric Dentistry: Total Patient Care. Philadelphia, PA: Lea and Febiger; 1988. p. 259-74.
Riekman GA, el Badrawy HE. Effect of premature loss of primary maxillary incisors on speech. Pediatr Dent 1985;7:119-22.
Gable TO, Kummer AW, Lee L, Creaghead NA, Moore LJ. Premature loss of the maxillary primary incisors: Effect on speech production. ASDC J Dent Child 1995;62:173-9.
[Figure 1], [Figure 2]