Anterior Middle Superior Alveolar Research Articles

Efficacy of anterior middle superior alveolar nerve block given by computerized‐controlled local anaesthesia delivery system (CCLAD) in the extraction of maxillary teeth—A randomized controlled trial

AbstractThe objective was to evaluate the efficacy of computerized‐controlled local anaesthesia delivery (CCLAD) system for extraction of maxillary teeth using the anterior middle superior alveolar (AMSA) nerve block technique in comparison to injection with a self‐aspirating syringe. A randomized, controlled trial with a split‐mouth design was conducted where each study sample (n = 17) was part of two groups. In group E (experimental group), AMSA nerve block was given using the CCLAD system and in group C (control group), AMSA nerve block was given using a self‐aspirating syringe for the extraction of orthodontically indicated maxillary premolar with age ranging from 18 to 25 years. The parameters assessed were pain during needle insertion and solution deposition, the profoundness of anaesthesia, the amount of local anaesthetic (LA) used, and the number of additional injections required. There was a statistically significant difference seen for amount of local anaesthetic used (p = 0.03, p < 0.05). Injection with self‐aspirating syringe was superior in terms of amount of LA used in injection with the CCLAD system. There was no relation between CCLAD and self‐aspirating syringe for the remaining criteria.

Pattern of buccal and palatal bone density in the maxillary premolar region: an anatomical basis of anterior-middle superior alveolar (AMSA) anesthetic technique.

BackgroundThe anterior-middle superior alveolar (AMSA) anesthetic technique has been reported to be a less traumatic alternative to several conventional nerve blocks and local infiltration for anesthesia of the maxillary teeth, their periodontium, and the palate. However, its anatomic basis remains controversial. The present study aimed to determine if the pattern of cortical and cancellous bone density in the maxillary premolar region can provide a rationale for the success of the AMSA anesthetic technique.MethodsCone-beam computed tomography scans of 66 maxillary quadrants from 34 patients (16 men and 18 women) were evaluated using a volumetric imaging software for cortical and cancellous bone densities in three interdental regions between the canine and first molar. Bone density was measured in Hounsfield units (HU) separately for the buccal cortical, palatal cortical, buccal cancellous, and palatal cancellous bones. Mean HU values were compared using the Mann-Whitney U test and one-way ANOVA with post-hoc analysis.ResultsCancellous bone density was significantly lower (P ≤ 0.001) in the palatal half than in the buccal half across all three interdental regions. However, there was no significant difference (P = 0.106) between the buccal and palatal cortical bone densities at the site of AMSA injection. No significant difference was observed between the two genders for any of the evaluated parameters.ConclusionsThe palatal half of the cancellous bone had a significantly lower density than the buccal half, which could be a reason for the effective diffusion of the anesthetic solution following a palatal injection during the AMSA anesthetic technique.

Anesthetic efficacy of anterior middle superior alveolar injection in single-visit endodontic therapy: an in vivo study.

To evaluate and compare the anesthetic efficacy of anterior middle superior alveolar (AMSA) injection in single-visit endodontic therapy, an in vivo study. Teeth in the maxillary anterior segment (N= 60) requiring single-visit endodontic (SVE) therapy were selected. A conventional syringe with 26-guage needle containing 1.5ml lignocaine with 1:80,000 epinephrine was used for the AMSA injection. The SVE therapy was performed using standard protocol. Profoundness of anesthesia during therapy was evaluated at 15-, 30-, 60-, and 90-min intervals using pain rating score and marked on visual analogue scale. In patients who reported pain/ineffectiveness of anesthesia during the course of endodontic therapy, additional supplemental anesthesia (buccal/labial infiltration) was administered. Depending on effectiveness of anesthesia with the AMSA injection alone or the need for additional supplementary injections, patients were divided as: group I-only AMSA and group II-AMSA with one or two supplemental anesthesia. The AMSA injection was effective in 91.67% of the patients undergoing the SVE therapy and the duration of anesthesia for the AMSA injection alone was adequate until the completion of the SVE therapy. Supplementary injections were required in 8.33% of cases at 15-min interval to achieve profound anesthesia. The AMSA injection technique could be used as an alternative to the conventional infiltration technique for anesthetizing teeth in maxillary anterior segment during the SVE therapy. The AMSA injection provides profound pulpal anesthesia of teeth in maxillary anterior segment during endodontic therapy.

Effectiveness of anterior middle superior alveolar injection using a computer-controlled local anesthetic delivery system for maxillary periodontal flap surgery.

BackgroundProfound anesthesia with adequate duration is required in periodontal flap surgery, which involves the manipulation of both hard and soft tissues. The anterior middle superior alveolar (AMSA) injection may be an alternative to multiple injections required for this purpose in the maxilla. The present study aimed to assess the effectiveness of AMSA injection using computer-controlled local anesthetic delivery (CCLAD) system to anesthetize buccal hard tissue (BHT), buccal soft tissue (BST), palatal hard tissue (PHT), and palatal soft tissue (PST) around the maxillary teeth.MethodsThirty-five patients who were indicated for open flap debridement in a whole maxillary quadrant were given AMSA injection using the CCLAD. The effectiveness of anesthesia was evaluated using subjective and objective parameters around each tooth. Supraperiosteal infiltrations were administered to complete the surgery wherever the AMSA injection was ineffective.ResultsThe AMSA injection was more effective on the palatal tissues than on the buccal tissues, as 94.14% of PST and 87.89% of PHT sites were anesthetized compared to 49.22% and 43.75% of BHT and BST sites, respectively. There was no significant difference in the frequency of anesthesia around the anterior and posterior teeth. The PHT was significantly more anesthetized (P = 0.003) in males than in females.ConclusionsThe AMSA injection using CCLAD is highly effective on palatal tissues and could be used as a first-line anesthesia for periodontal flap surgery. However, its effect on buccal tissues is less predictable, with supraperiosteal infiltration often required to supplement the AMSA injection.

Efficacy and safety of 4% articaine with epinephrine for the anterior middle superior alveolar nerve block comparing to the computer-controlled and conventional anesthetic delivery: Prospective, randomized, cross-over clinical study

Bacground/Aim. The efficient dental anesthesia, which is related to the clinically adequate depth, duration and the width of anesthetic field, is an important prerequisite for successful dental treatment. The aim of this study was to investigate and compare the pulpal anesthesia and cardiovascular parameters after the anterior middle superior alveolar (AMSA) nerve block with 4% articaine with epinephrine administered by conventional cartridge-syringe and computer- controlled local anesthetic delivery system (CCLADS). Methods. This controlled double-blind cross-over randomized clinical study included 38 healthy volunteers. Efficacy of pulpal anesthesia after the AMSA nerve block was evaluated by measuring a success rate, onset and duration of pulpal anesthesia, using an electrical pulp tester. The parameters of cardiovascular function (systolic and diastolic blood pressure, heart rate) were monitored noninvasively. Results. Successful pulpal anesthesia of all tested teeth was obtained in 57.9% participants with CCLADS and in 44.7% participants with conventional syringe. The onset time was not significantly different between two investigated groups. The pulpal anesthesia duration was not significantly different neither within nor between investigated groups. The systolic and diastolic blood pressures were significantly decreased in both investigated groups, in comparison with the baseline values. Heart rate significantly decreased within CCLADS from 10th to 30th minute when compared to baseline. Conclusion. The efficacy of pulpal anesthesia and safety of cardiovascular profile of 0.6 mL of articaine with epinephrine (1:100.000) delivered with CCLADS were improved in comparison to the conventional syringe delivery. Significant changes of cardiovascular function were not observed.

Current status of the anterior middle superior alveolar anesthetic injection for periodontal procedures in the maxilla.

Periodontal procedures require adequate anesthesia not only to ensure the patient's comfort but also to enhance the operator's performance and minimize chair time. In the maxilla, anesthesia is often achieved using highly traumatic nerve blocks, apart from multiple local infiltrations through the buccal vestibule. In recent years, anterior middle superior alveolar (AMSA) field block has been claimed to be a less traumatic alternative to several of these conventional injections, and it has many other advantages. This critical review of the existing literature aimed to discuss the rationale, mechanism, effectiveness, extent, and duration of AMSA injections for periodontal surgical and non-surgical procedures in the maxilla. It also focused on future prospects, particularly in relation to computer-controlled local anesthetic delivery systems, which aim to achieve the goal of pain-free anesthesia. A literature search of different databases was performed to retrieve relevant articles related to AMSA injections. After analyzing the existing data, it can be concluded that this anesthetic technique may be used as a predictable method of effective palatal anesthesia with adequate duration for different periodontal procedures. It has additional advantages of being less traumatic, requiring lesser amounts of local anesthetics and vasoconstrictors, as well as achieving good hemostasis. However, its effect on the buccal periodontium appears highly unpredictable.

Nutrient canals and porosity of the bony palate: A basis for the biological plausibility of the anterior middle superior alveolar nerve block

BackgroundThe authors investigated morphologic parameters of the palatal cortex that affect the diffusion of local anesthetic solution in the region of the anterior middle superior alveolar (AMSA) nerve block injection site. MethodsThe authors used computed tomographic (CT) and micro-CT imaging to assess 20 human skulls from an anatomic collection. Analysis of the CT images included frequency, distribution, and width of the nutrient canals in the bony palate, according to to the person’s sex and age. Micro-CT analysis involved measuring the thickness and porosity of palatal cortical bone in the area of the AMSA injection site in relation to the thickness and porosity of the opposite buccal cortical bone. ResultsThere was a statistically significant difference (P = .042) in the location of the nutrient canals between male specimens (> 50% in the border region) and female specimens (> 50% in the palatal process). Furthermore, the female skulls had significantly wider nutrient canal foramina (P = .042) than did the male skulls. Despite greater thickness, the palatal cortex in the area of the AMSA injection site had slightly greater porosity than did the buccal cortex. A significantly greater number of microcanals penetrated the whole cortical thickness in palatal than in buccal cortical bone (P = .001). ConclusionsThe distribution and width of nutrient canals differed between male and female skulls. At the microscopic level, structural characteristics of the palatal cortex provide a good anatomic basis for the potential of a satisfactory AMSA injection success rate. Practical ImplicationsThe AMSA technique success rate might be increased if the clinician adjusts the injection site to the distribution of nutrient canals, depending on the sex of the patient.

Comparing the anterior middle superior alveolar nerve block and infraorbital nerve block for maxillary anterior teeth anesthesia: A randomized clinical trial

ObjectiveTo compare the efficacy of the Anterior Middle Superior Alveolar nerve block with that of the Infra-orbital nerve block in achieving anesthesia in the anterior maxillary teeth. Study designWe recruited 62 patients who underwent vital tooth/teeth extraction under local anesthesia. We divided the patients into two groups: group A received Anterior Middle Superior Alveolar (AMSA) nerve block and group I received Infra-orbital nerve block (IONB). We assessed the Pulpal anesthesia by Pulp Tester with 0–10 digital reading, soft tissue anesthesia by pricking with periosteal elevator and injection pain using10 cm VAS (Visual Analogue Scale) score. We entered collected data in Microsoft excel 2010 and categorical variables analysed using Chi Square test and non-categorical variables analysed using Independent t (parametric) and Mann Whitney U (non-parametric) tests. ResultsWe achieved significantly higher pulpal anesthesia with infra-orbital nerve block for canine (p = .04) and 1st premolar (p = .02) as compared to anterior middle superior alveolar nerve block; but no significant difference was found in pulpal anesthesia for 2nd premolar, central and lateral incisors. The labial gingival anesthesia was significantly higher with infra-orbital nerve block than with anterior middle superior alveolar nerve block (p < 0.001). The VAS score in group I was 5.2 ± 2.1 (mean ± SD) and that in group A was 3.9 ± 1.3 (mean ± SD) which was statistically significant (p = .004). ConclusionAnterior middle superior alveolar nerve block resulted in inadequate pulpal and soft tissue anesthesia but less injection pain. Infra-orbital nerve block produced higher pulpal anesthesia for 1st premolar and canine but more injection pain.

The Maxillary Neurovascular Canals as the Basis for the Local Anesthesia Efficacy

It is not known the way in which a local anesthetic, following the Anterior Middle Superior Alveolar (AMSA) anesthesia, reaches the superior dental plexus. Consequently, the aim of the study was to examine the possible route of diffusion of a local anesthetic from the anterior lateral palatal injection to the superior dental plexus. The palatal and alveolar regions of 48 dry maxillae were examined and 6 autopsy specimens of the same region were prepared for histological and immunohistochemical analysis. The study revealed palatal and alveolar process openings in all the specimens. They average 6.3 in number close to the central incisor, 5.2 to the lateral incisor, 3.7 to the canine, 3.8 to the 1st premolar, and 3.9 to the 2nd premolar. The microscopic structure of the epithelium, lamina propria, submucous layer, arteries and nerves, periosteum, and cortical and spongious bone was described in detail. The neurovascular pores and canals had a diameter of their opening of 90.28–1,230.62 μm (mean, 893.62 μm). The initial part of the canals varied in diameter between 523.42 μm and 903.04 μm (mean, 622.93 μm). The canals penetrated the cortical bone and usually terminated in the spongious bone towards the alveolar process. They contained a larger artery or several smaller arteries, some veins, a few tiny nerves, collagen fibers type I, and small collections of the fatty cells. The neurovascular canals and the pores most likely represent a route for diffusion of an anesthetic from the lateral palatal region to the superior dental plexus.

A randomized clinical trial to compare the anterior middle superior alveolar nerve block with infraorbital nerve block for anesthesia of maxillary anterior teeth

Background: Multiple injections are required for extraction of upper anterior teeth. Anterior Middle Superior Alveolar (AMSA) nerve block has shown to be effective in anesthetizing the upper teeth and gingiva.

Anterior Middle Superior Alveolar Nerve Block Efficacy Utilizing different Anesthetic Solutions, Reduced Dosage and Conventional Syringe: A Breakthrough in Pain Control

ABSTRACT Introduction For over a decade of introducing the anterior middle superior alveolar (AMSA) injection, it has since majorly only been reported to show both pulpal and buccal mucosal effectiveness using a minimum of 0.9 ml of anesthetic solution. Aim The aim of this study was to demonstrate the AMSA nerve block efficacy using a reduced dosage and conventional syringe, while comparing the anesthetic effectiveness of lidocaine vs mepivacaine. A primary objective was to understand the behavioral difference between the two solutions, to better adapt their application into relevant clinical scenarios, where fewer injections are administered, pain control is better understood and implemented, and collateral anesthesia altering the natural lip line is eliminated. Materials and methods Twelve candidates (both sexes), of ages 18 to 24, were selected. All the participants received bilateral AMSA nerve block (split-mouth technique) using the conventional syringe, where 0.6 ml of lidocaine and mepivacaine 2% with epinephrine 1:100,000 were randomly administered to each side. Results Pulpal anesthesia on both premolar teeth showed 83.3% success within 15 minutes with lidocaine group (LG) and mepivacaine group (MG) alike. Buccal anesthesia at both premolar teeth showed 50% success within 15 minutes with LG and 54.2% with MG. There was no difference in anesthetic effectiveness between the two groups in pulpal anesthesia (p ≥0.05), and no significant difference in buccal mucosal anesthesia (p ≥0.05). Conclusion No statistically significant difference was observed between lidocaine and mepivacaine, while both expressed anesthetic effectiveness using a reduced dosage, as well as near painlessness using the conventional syringe. How to cite this article Tattan M, Kokovic V. Anterior Middle Superior Alveolar Nerve Block Efficacy Utilizing different Anesthetic Solutions, Reduced Dosage and Conventional Syringe: A Breakthrough in Pain Control. Int J Experiment Dent Sci 2015;4(2):80-86.

Comparison of pain intensity of anterior middle superior alveolar injection with infiltration anesthetic technique in maxillary periodontal surgery

PurposeThe aim of the present clinical trial was to compare pain during injection of anterior middle superior alveolar (AMSA) technique with that of infiltration injection technique in the maxilla in periodontal flap surgeries of patients referring to the Department of Periodontics, Faculty of Dentistry, Tabriz University of Medical Sciences.MethodsTwenty subjects with an age range of 20 to 40 years were selected for the present study. One side of the maxilla was randomly selected as the test side and the other as the control side using a flip of a coin. AMSA technique was used on the test side and infiltration technique was used on the control side for anesthesia. On both sides 2% lidocaine containing 1:80,000 epinephrine was used for anesthesia. The operator obtained the visual analogue scale for each patient immediately after the injection and immediately after surgery. Data was analyzed using descriptive statistical methods (frequency percentages, means and standard deviations) and Wilcoxon's test using SPSS ver. 13 (SPSS Inc.). Statistical significance was defined at P<0.05.ResultsThere were no statistically significant differences in pain during injection between the two techniques (P=0.856). There were statistically significant differences in postoperative pain between the two injection techniques (P=0.024).ConclusionsPostoperative pain in AMSA injection technique was less than that in the infiltration technique. Therefore, the AMSA technique is preferable in the periodontal surgeries for the anesthesia of palatal tissues given the fact that it has other advantages, too.

A Comparison of the Anterior Middle Superior Alveolar Nerve Block and Infraorbital Nerve Block for Anesthesia of Maxillary Anterior Teeth

The authors conducted a study to compare the efficacy of the anterior middle superior alveolar (AMSA) nerve block with that of the infra-orbital nerve block (IONB) in achieving pulpal anesthesia in the anterior maxilla. Twenty-eight healthy adult volunteers received 1.0 milliliter of 2 percent lidocaine with 1:80,000 epinephrine as an AMSA nerve block or IONB via computer-controlled local anesthetic delivery (CCLAD) across two visits. The authors used electronic pulp testing to measure pulpal anesthesia. Participants provided subjective reports of lip numbness and injection discomfort. The authors analyzed the data by using the McNemar, Mann-Whitney and t tests. Anesthetic success, defined as two or more consecutive episodes of no sensation in response to maximal stimulation, was significantly greater with the AMSA nerve block than with the IONB in central (P = .012) and lateral (P < .001) incisors; however, anesthesia was achieved in only 42.9 percent of central incisors with the AMSA nerve block. The authors observed a significantly greater number of episodes of no response in the premolar and canine teeth after IONB. Onset of anesthesia was shorter after IONB in canines (P = .002) and central incisors (P = .022). The incidence of subjective lip numbness was 100 percent after IONB and 14.3 percent after AMSA nerve block (P < .001), with numbness lasting twice as long after IONB (P = .019). The authors noted no significant difference in injection discomfort between the two techniques (P = .768). The IONB produced anesthetic success in canine and premolar teeth, with a more rapid onset than that for the AMSA nerve block. Although the AMSA technique was significantly more successful than IONB in attaining incisor anesthesia, it was ineffective for central incisors, as assessed according to rigorous electronic pulp testing. The IONB and AMSA nerve block produced similar levels of injection discomfort.

Anterior Middle Superior Alveolar Injection Is Effective in Providing Anesthesia Extending to the Last Standing Molar in Maxillary Periodontal Surgery

Multiple injections are required to anesthetize the maxilla for periodontal surgery that involves a quadrant or multiple teeth across the midline. The anterior middle superior alveolar (AMSA) field block was reported to effectively anesthetize the central incisors to the mesial aspect of the first molar of the maxilla with one or two injections. To our knowledge, the extent of anesthesia has not been reported beyond first molars in the literature. Fifty subjects who were indicated for periodontal surgery were provided maxillary anesthesia with an AMSA injection through a conventional syringe with a 27-gauge needle. All subjects were given an AMSA injection, and after surgery, they were assigned to group 1 (requiring only the AMSA injection), group 2 (requiring one supplemental buccal infiltration), or group 3 (requiring two supplemental buccal infiltrations). Subjective and objective signs and symptoms were used to confirm the extent and profoundness of the anesthesia at 90, 120, and 180 minutes. Statistical significance for groups 1 and 2 was observed for anesthesia at different time intervals during the course of periodontal surgery. Pairwise comparisons of groups showed no statistical significance. The profoundness of the anesthesia extended to the last standing molar. The AMSA injection provided excellent, wide-spread anesthesia in all groups for the required time of surgery, and there was no significant implication among groups. The AMSA injection can be used as an effective technique to anesthetize teeth distal to the first molar up to the last standing molar in maxillary periodontal surgery.

Comparison of the pain levels of computer-controlled and conventional anesthesia techniques in prosthodontic treatment

Objective:The objective of this study was to compare the pain levels on opposite sides of the maxilla at needle insertion during delivery of local anesthetic solution and tooth preparation for both conventional and anterior middle superior alveolar (AMSA) technique with the Wand computer-controlled local anesthesia application.Material and methods:Pain scores of 16 patients were evaluated with a 5-point verbal rating scale (VRS) and data were analyzed nonparametrically. Pain differences at needle insertion, during delivery of local anesthetic, and at tooth preparation, for conventional versus the Wand technique, were analyzed using the Mann-Whitney U test (p=0.01).Results:The Wand technique had a lower pain level compared to conventional injection for needle insertion (p<0.01). In the anesthetic delivery phase, pain level for the Wand technique was lower (p<0.01). However, there was no difference between the Wand and conventional technique for pain level during tooth preparation (p>0.05).Conclusions;The AMSA technique using the Wand is recommended for prosthodontic treatment because it reduces pain during needle insertion and during delivery of local anaesthetic. However, these two techniques have the same pain levels for tooth preparation.

Alternative Anesthetic Technique for Maxillary Periodontal Surgery

Maxillary periodontal surgery typically requires multiple injections and may inadvertently affect facial structures such as the upper lip, lateral aspect of the nose, and lower eyelid. To minimize these sequelae and reduce the number of total injections, a relatively new injection technique has been proposed for maxillary procedures. The anterior middle superior alveolar (AMSA) injection is reported to effectively anesthetize maxillary teeth and associated gingival tissues extending from the buccal root of the first molar mesially to the central incisor with a single injection while avoiding undesirable side effects. The purpose of this article is to provide background information on the AMSA injection and demonstrate its use in a variety of maxillary periodontal surgeries. Anesthesia was provided for five separate maxillary periodontal surgeries with unilateral or bilateral AMSA injections. Injections were administered via conventional syringe with a 27-gauge needle. Confirmation of anesthesia was subjectively tested with buccal mucosal sticks and palatal transgingival probing. The AMSA injection provided promising results for a variety of maxillary periodontal surgical procedures. Benefits of the AMSA injection included outstanding palatal hemostatic control, avoidance of undesirable collateral anesthesia, and a reduced number of cumulative injections. Drawbacks of the AMSA injection included occasionally inadequate buccal hemostatic control and short-lived anesthesia of the maxillary central incisors. The AMSA injection is a novel anesthetic technique that may prove useful for certain maxillary periodontal surgeries.

Computer-controlled delivery versus syringe delivery of local anesthetic injections for therapeutic scaling and root planing

The authors conducted a study to compare administration of local anesthetic using a computer-controlled delivery device with an aspirating syringe for therapeutic scaling and root planing. The anterior middle superior alveolar, or AMSA, injection was compared with other maxillary injections. Twenty healthy adults with moderate periodontal disease participated in this single-blind crossover study. Subjects were evaluated by a trained examiner and were treated by experienced dental hygienists. Subjects provided written and verbal pain ratings via a visual analog scale, or VAS, and a verbal rating scale, or VRS. AMSA injections were compared with syringe-delivered injections--greater palatine, or GP, and nasopalatine, or NP, blocks, and anterior superior alveolar and middle superior alveolar injections--in maxillary quadrants. Bleeding and changes in attachment were evaluated after one month. VAS and VRS scores for AMSA were significantly lower for computer-controlled delivery when compared with NP injections and combined maxillary injections (VAS scores) and with GP and combined maxillary injections (VRS scores). Mean injection times were similar for both groups. Mean gains in attachment were equal, 0.19 millimeters for quadrants anesthetized using computer-controlled injections and 0.22 mm for syringe injections. Subjects reported having less pain with GP and NP injections delivered using the computer-controlled device, and total injection time was similar to that required for syringe injections. Both techniques provided adequate anesthesia for therapeutic scaling and root planing. Clinical Implications. The two anesthetic delivery techniques were therapeutically equivalent for mandibular injections, and the AMSA injection has clinically significant advantages for maxillary injections.