Growth-enabling modified Groper appliance for the replacement of permanent maxillary incisors: Report of two cases

The aim of this case report is to introduce a modified Groper appliance that enables transverse growth of the maxilla in addition to improving the aesthetics of patients with missing anterior teeth. Patient 1 was a 16-year-old young woman in the late stages of growth who presented with a congenitally missing maxillary lateral incisor. Patient 2 was a nine-year-old girl missing both of her maxillary central incisors due to trauma. The missing teeth were replaced by artificial acrylic teeth bonded onto growth-enabling, maxillary, fixed palatal space maintainers. A tube was soldered onto one of the arch wires of the maintainer and the opposite arch wire was threaded into this tube, allowing it to slide until the patient completed growth. Intermolar width increased by approximately 1.9 mm in Patient 1 and 2.6 mm in Patient 2 over the three-year review period. The in-tube mechanical design of the device allowed transverse growth of the maxilla without interference during and throughout long-term wear.