Beyond Conventional Groper Appliance: A Modified Design for Dental Rehabilitation in Nephrotic Syndrome

Groper appliance is a fixed esthetic space maintainer used to replace prematurely lost primary anterior teeth while supporting esthetics, oral function, and space maintenance. This case report describes the oral rehabilitation of a four-year-old girl with nephrotic syndrome in remission who presented with extensive dental caries affecting both the anterior and posterior primary dentition. The patient's medical condition was stable, and dental treatment was carried out in consultation with the pediatric nephrologist. Physician-directed medical precautions, including antibiotic coverage and corticosteroid supplementation, were implemented before invasive dental procedures to minimize potential complications. Clinical examination revealed chronic irreversible pulpitis and dentinal caries involving multiple teeth. Comprehensive dental management included pulp therapy, glass ionomer cement restorations, and the fabrication of a modified Groper appliance to replace the missing maxillary primary anterior teeth and compensate for the premature loss of the maxillary first primary molars. The appliance provided satisfactory esthetic rehabilitation with favorable short-term clinical outcomes, and both the patient and parents expressed satisfaction with the treatment. This case highlights the importance of early diagnosis, interdisciplinary management, and timely oral rehabilitation in medically compromised children and demonstrates the potential role of a modified Groper appliance as a practical treatment option in selected cases.