QUICK-NANCE

Images of Construction of Quick-Nance.

Indications for Use:

The Quick- or Insta-Nance appliance is utilized com-monly to stabilize the molars in their overcorrected locations. The advantages are numerous. Compliance is not needed as the palatal vault is still utilized for anchorage; it can be placed immediately after removal of the Pendulum Appliance and it prevents virtually any rebound. Common sense would tell us that the palatal vault would be too inflamed for immediate placement of the Nance. This has proven not to be the case. Since there is some supraeruption of the buccal segments during Pendulum usage, the acrylic tends not to impinge heavily on the palatal tissues. Quite often, the tissues are pink and healthy and allow for immediate placement. The Quick-Nance can also be used in conjunction with multiple other anchorage techniques, such as overcorrection, utility arches, stops at molars, Class II elastics, and early bonding of the upper arch.

Technique:

A series of preformed Nance cribs (available soon from Ormco) fabricated from .032 stainless steel is used to make the Quick-Nance. The authors take an impression of the upper arch at the appointment prior to Pendulum removal. This allows for preselection of the proper Nance crib (there are 5 sizes). The .032 wire size is utilized because it is easily placed recurved to fit into the .036 lin-gual sheath. Although the wire fits quite loosely into the sheath, it is stable enough once the acrylic button has been formed. After the pendulum appliance has been removed, the patient is instructed to brush the roof of the mouth. The crib is then fitted into the lingual sheaths. Since the upper molars have been tipped back a bit, the anterior portion of the crib should be somewhat away from the palatal rugae. This is desirable at this point as you need to bend the crib down into the soft acrylic so that there is no void under the button after fabrication. The roof of the mouth is thoroughly dried with an air syringe so that the soft acrylic button doesn’t flow prematurely. A ball of Triad light-set acrylic approximately 1 cm in diameter is formed and placed up against the rugae at the greatest depth of palatal vault, and the Nance crib is bent into the acrylic ball, using a three-pronged pliers (just mesial to the molar lingual sheaths).

The button is then smoothed and contoured around the retention loop of the Nance crib, making sure that there are no voids and that all the edges have been rounded for comfort. This is best accomplished with the Teflon blade that accompanies the Triad acrylic and can be further smoothed with a moistened finger. A Kulzer light is then used to set the acrylic button. The patient is informed that the acrylic might become slightly warm and to raise their hand if it becomes uncomfortable. The acrylic is set in four 20-sec. bursts of light (1 min., 20 sec. overall), giving a few seconds between each burst to allow for cooling of the acrylic as necessary. The patient is then instructed on the cleansing and care of the newly placed Quick-Nance appliance.

Considerations:

Although the Quick-Nance is the appliance of choice in many Pendulum cases, there are certainly contraindications and precautions. The Nance button cannot be placed over already inflamed or compressed tissue. When the palatal tissue is inflamed, the use of a clear immediate (Tru-Tain type) retainer for approximately one week will allow for adequate recovery of the tissue. This retainer must be placed immediately to prevent the almost instantaneous rebound. It is also not judicious to place immediate and heavy retracting forces against the Nance button, as you will surely bury the button in the tissue. Normally, the buccal segments are allowed to drift distally for six to ten weeks before any retractive force is placed upon them. If the buccal segments can be "floated" distally (not sliding along an arch wire), this will further reduce the pressure on the Nance button. It is quite common to use an upper utility arch and an elastomeric chain to free-float the buccal teeth back into Class I positions. Patience is the key here. Quite often, when the Pendulum Appliance has been used in Phase I and the permanent buccal teeth have yet to erupt, the Quick-Nance will serve as the only anchorage unit. The upper buccal teeth will drift distally as they erupt, further simplifying the overall mechanics.