Iatrogenic fibrotic encapsulation of NANCE palatal arch appliance in the hard palate and its surgical management: a case report

Fibrosis is the overgrowth of connective tissue resulting from chronic inflammatory reactions induced by persistent tissue injury such as iatrogenic injury from prolonged use of orthodontic appliances. We report a case of a 19-year-old female who presented with a complaint of dental malocclusion. Her first presentation was 5 years prior when she received a Nance palatal arch appliance. However, she did not keep to her follow-up appointments and could not complete her treatment. Intraoral examination revealed the Nance palatal arch appliance completely buried in fibrotic tissue of the hard palate. The appliance was resistant to removal by conventional means and surgical exposure and removal were performed. A new Nance palatal arch appliance was fabricated and fitted and the patient continued to receive further orthodontic treatment. This report elucidates the importance of regular dental appointments for patients on orthodontic therapy to prevent complications and minimize the need for surgical interventions.