Nance appliance or Nance palatal holding arch is a modified maxillary lingual arch, described by Nance in 1947.
It is basically a maxillary lingual arch that does not contact the anterior teeth, but approximates the anterior palate.
Design Consideration
- Nance appliance consists of a 0.036-inch SS wire that traverses the arch, and an acrylic button positioned at the midline against the anterior palatal contour.
- The wire is soldered at both ends to bands cemented on maxillary molars.
- The acrylic button acts as an anterior stop for bilateral molar stabilisation in the maxillary arch, and provides some additional resistance against forward tipping movements of the molars.
- It provides molar rotation and bodily movement control similar to the transpalatal arch.
Indications
- Missing multiple primary posterior teeth, where permanent first molar have erupted.
- In patients with deep bite, where maxillary lingual arch is contraindicated.
Advantages
- It is economical when compared to using two band and loop space maintainers.
- Prevents mesial migration and rotation of permanent molars, where primary second molars are lost.
- Allows transverse growth in the inter-canine areas.
- Allows transverse growth in inter-molar (permanent) areas, if deciduous second molars are used as abutments
Disadvantages
- Palatal soft tissue irritation can be a problem.
- Food may accumulate beneath the palatal button, if proper hygiene measures are not followed.
- The acrylic portion can become embedded in the soft tissue if the palatal tissue hypertrophies because of poor oral hygiene, or if the appliance is distorted.
- Requires more clinical skills and dexterity.
- If permanent molars are used as abutments, it does not allow inter-molar transverse growth.
References
- Orthodontics Current Principles and Techniques, 5th Edition, Xubair, Graber, Vanarsdall, Vig, Elsevier Mosby.
- The Transpalatal Arch : An alternative to the Nance appliance for space maintenance, Clinical Article, Pediatric Dentistry V29/ No 3, May/June 07, Ari Kupietzky, DMD MSc, Eli Tal, DMD
- McDonald and Avery's Dentistry for the Child and Adolescent, 11th Edition, Jeffrey A. Dean, Elsevier Mosby.
- Textbook of Orthodontics (2nd Edition), Gurkeerat Singh, Jaypee Brothers Medical Publishers (P) Ltd.
*This article is an excerpt from the above mentioned sources and Medical Sutras does not make any ownership or affiliation claims.