Modified Nance Palatal Arch: A Case Report

Abstract

Premature loss of primary molars during mixed dentition may permit undesirable movement of adjacent teeth and reduce the available arch space. This case report describes the clinical use of a modified Nance palatal arch incorporating a canine stopper as a fixed space-maintaining appliance after extraction of maxillary primary molars. A 10-year-old male patient presented with pain in the upper anterior region. Clinical examination identified caries, failed restorations, pathological root resorption, and poor prognosis involving several maxillary primary molars scheduled for extraction. Following extraction, bilateral fixed space maintenance was planned. Bands were adapted to the maxillary first permanent molars, and a 0.9-mm stainless-steel wire framework with an acrylic palatal button was fabricated. The conventional Nance appliance was modified by adding a canine stopper to provide an additional point of control in the canine region. Intraoral evaluation confirmed satisfactory adaptation and retention before cementation. Oral-hygiene and follow-up instructions were provided to the patient and parent. At three and six months, the appliance remained stable and securely retained, without clinically evident soft-tissue complications or appliance failure, and the canine stopper remained in its intended position. This case supports the clinical feasibility of the modified design; however, objective measurements and longer follow-up are required to determine whether the canine stopper provides measurable additional space-maintenance benefit.