With #3 and #4 erupted and multiple primary teeth lost bilaterally in the MAXILLA, which appliance is most appropriate for space maintenance?

Correct answer: C. Nance holding arch

• A. A band and loop maintains the space of a SINGLE tooth in ONE quadrant. It cannot hold bilateral spaces, and multiple band-and-loop appliances in one arch are unstable and prone to distortion.
• B. A lingual arch is the MANDIBULAR equivalent for bilateral maintenance. It cannot be used in the maxilla, where the tongue would displace it and where the palate provides the anchorage instead.
• C. CORRECT. A NANCE HOLDING ARCH is the maxillary appliance for BILATERAL space maintenance. Bands on the permanent first molars are joined by a palatal wire carrying an acrylic button that rests against the anterior palatal rugae, resisting mesial molar movement. It preserves arch length while the anterior segment is unrestrained, which is exactly what this arch needs.
• D. A distal shoe is used when the second primary molar is lost BEFORE the first permanent molar erupts, guiding it into position with a subgingival extension. In this patient #3 has already erupted, so the indication has passed.

Note: Match the appliance to the arch and to the number of spaces. Unilateral single space: band and loop. Bilateral MANDIBULAR: lingual arch — and only once the permanent incisors have erupted, or it interferes with their eruption path. Bilateral MAXILLARY: Nance holding arch, or a transpalatal arch where some rotational control is also wanted. Second primary molar lost before the first permanent molar erupts: distal shoe.