Upgrading Conventional Space Maintainers using GrADS Appliance: A Case Report

Abstract

Background: Premature loss of primary teeth due to untreated severe early childhood caries (SECC) leads to space loss, increased frequency of malalignment, and crowding in the successor permanent dentition. Owing to the prevalent negligence and delay in accessing care, multiple extractions in a dental arch result in complex presentations, rendering conventional space maintainer (SM) designs counterproductive. Aim: This case report aims to highlight a unique customized and improvised design—Groper’s appliance with distal shoe modification (GrADS), for a 5-year-old boy suffering from delayed consequences of SECC. Case description: Full-mouth rehabilitation, including multiple extractions, was undertaken, following which a novel appliance was conceptualized combining the design of Nance palatal arch, distal shoe SM, and Groper’s appliance to successfully meet all the requirements and optimally preserve arch integrity. Regular follow-up allowed the documentation of the eventual success of the appliance. Conclusion: Customized designs can pave the path of change in preventive and interceptive orthodontics for children.

Keywords

• early childhood caries
• fixed appliance
• interceptive orthodontics
• primary teeth
• space maintenance