Improving Nance Button Use

Now that many of us have migrated our anchorage needs to miniscrews, there is less call for Nance buttons as anchorage enhancers.  They still have a use though.  Here are some ideas on optimizing the use of Nance buttons as well as reducing patient problems:

1. Keep the acrylic portion as large as possible.  Think half dollar not nickel sized acrylic.  The use of larger acrylic buttons reduces the pressure in any particular area.
2. Don’t impinge on the incisal papilla.
3. Ask your lab to use Triad gel for the acrylic portion and not to treat the tissue side of the acrylic with any type of oxygen barrier to eliminate the oxygen inhibition layer.
4. When delivering the appliance, place a thin layer of Triad gel on the entire tissue surface and seat the appliance to the same degree you would if cementing it.  This can be delegated.
5. Light cure the Triad gel in the mouth for 15 seconds.  It gets very warm so don’t overdue the curing time.  This can be delegated.
6. Continue to light cure out of the mouth and trim the excess.  This can also be delegated.
7. Cement the appliance as your normally would.

The Triad gel addition before cementation creates a truly customized appliance with a very intimate adaptation to the patients soft tissue.  This will virtually eliminate emergencies since nothing will be able to lodge underneath the acrylic and cause discomfort.  Also, by having a custom surface, you reduce any pressure points during the use of the Nance button.  When you remove the appliance, you will be amazed at how healthy the tissue looks.

Please feel free to comment or ask questions below.