A 7-year-old patient has multiple missing primary teeth in the UPPER arch with no developing tooth buds except for erupted permanent first molars (#3 and #14). What is the most appropriate space maintainer for this maxillary bilateral multiple-tooth loss situation?

The Nance palatal arch is the preferred bilateral fixed space maintainer for the UPPER (maxillary) arch when multiple primary teeth are missing. It consists of: bands cemented on permanent first molars (#3 and #14), a palatal wire running anteriorly along the midpalatal raphé, and an acrylic button resting on the anterior palate to resist mesial drift of the molars. The BAND AND LOOP is a unilateral (one-tooth space) maintainer — not appropriate for bilateral or multiple tooth loss. The DISTAL SHOE is used BEFORE eruption of the first permanent molar to guide its path of eruption. Since #3 and #14 are already erupted, the distal shoe is NOT indicated. The Nance arch effectively prevents mesial migration of permanent molars and holds space for premolar eruption.