Anterior Superior Alveolar Nerve Research Articles

Anatomy and function of the canalis sinuosus and its injury prevention and treatment strategies in implant surgery

The canalis sinuosus, a canal containing the anterior superior alveolar nerve bundle, originates from the infraorbital canal and extends along the maxillary sinus and nasal cavity edges to the anterior maxilla. It was once regarded as an anatomical variation. However, with the widespread application of cone beam computed tomography (CBCT), the detection rate of canalis sinuosus in the population has increased. The canalis sinuosus exhibits diverse courses, branching into multiple accessory canals and terminating at the nasal floor or the anterior tooth region, with the majority traversing the palatal side of the central incisor. The anterior superior alveolar nerve bundle within the canalis sinuosus not only innervates and nourishes the maxillary anterior teeth and the corresponding soft tissues, and the maxillary sinus mucosa, but also relates to the nasal septum, lateral nasal wall, and parts of the palatal mucosa. To minimize surgical complications, strategies for preventing and treating canalis sinuosus injuries need to be investigated. Preoperatively, CBCT is used to identify the canalis sinuosus and to virtually design implant placement at a distance of more than 2 mm from the canalis sinuosus. Intraoperatively, assessing bleeding and patient comfort, complemented by precision surgical techniques such as the use of implant surgical guide plates. Postoperatively, CBCT is used to examine the relationship between the implant and the canalis sinuosus, and treatment of canalis sinuosus injuries can be tailored based on the patient's symptoms. This review summarizes the detection of canalis sinuosus in the population, its anatomical characteristics, and the physiological functions in the anterior maxilla, and discusses strategies for avoiding canalis sinuosus injuries during implant surgery, thereby enhancing clinical awareness and providing references for clinical decision-making.

Evaluation of the Accessory Canals of Canalis Sinuosus Via Cone Beam CT

Objective: Canalis sinuosus (CS) is a common anatomical variation in the anterior maxilla that originates from the infraorbital canal and carries the anterior superior alveolar nerve and vessels. This study aimed to examine the presence, frequency, and features of CS and its accessory canals (ACs) using cone beam computed tomography (CBCT) images.
 Methods: A total of 495 CBCT images were retrospectively analyzed in axial, sagittal, and coronal sections. Patient age and sex, presence or absence of CS, location as right, left, or bilateral if CS was present, and number of ACs were recorded. In addition, the end regions of the ACs were recorded as central incisor, central-lateral incisor, lateral incisor, lateral incisor-canine, and canine regions. All recorded data were statistically analyzed.
 Results: At least one CS was found in 54 (10.9%) of 495 CBCT images. CS(s) were bilateral in 26 (48.2%) cases and unilateral in 28 (51.8%; 25 on the left and 3 on the right side). The ACs of the CS predominantly terminated in the lateral incisor region (p =.025). The frequency of CS was not statistically different between males and females (p =.313).
 Conclusion: Accessory canals in the anterior maxilla are mostly associated with branches of the CS. In the current study, the prevalence of CS was 10.9%, and most of the CSs were opening in the lateral incisor region. Detection of accessory canals in the anterior maxilla and examination of this region with CBCT will prevent misdiagnoses and postoperative complications arising from damage to these structures.

Prevalence and localization of Canalis Sinuosus: a mini review

In recent years, scientific literature has been focusing on the study of the Canalis Sinuosus (CS); this canal contains the anterior superior alveolar nerve (ASAN), together with bundles. Accordingly, the CS may vary its frequency and anatomical features. These variations can be identified through imaging technologies such as cone beam computed tomography (CBCT). The aim of this mini review is to present the current understanding of the CS, its prevalence and localization in order to decrease the potential surgical risk associated with this region. As revealed by the analysis of the international literature available, presence of CS is a crucial factor to consider in implantology and generally in oral surgery procedures in this area. In conclusions the use and analysis of CBCT imaging in the diagnosis stage is fundamental to preserve the most important anatomical structures which are present in the jaws.

Middle superior and anterior superior alveolar nerve injury following trauma to the maxillary sinus: a prospective clinico-radiographic evaluation.

Anterior maxillary sinus wall fractures are common in all types of maxillofacial trauma. They can result in various complications, including injury to the surrounding nerves. Owing to its anatomy, trauma to the maxillary antrum can result in injury to the middle superior alveolar nerve (MSAN) and the anterior superior alveolar nerve (ASAN). The purpose of this study is to evaluate neurosensory deficits (NSD) present in maxillary gingiva, incisors, and premolars after injury to the anterior wall of the maxillary antrum. This prospective study was conducted among 39 patients sustaining unilateral fractures of the anterior maxillary sinus wall. Clinical neurosensory tests including two-point discrimination and fine touch discrimination were performed to classify the extent of nerve injuries as mild, moderate, severe, or anesthetic. Additional temperature discrimination and pulpal sensibility tests (electric pulp testing and cold testing) were carried out. A comparison of radiographic fracture patterns and severity of nerve injury was done. Testing was carried out immediately after trauma and at 2-month follow-up. More than half of the patients assessed in the study group presented with NSD of the teeth and gingiva after trauma. The incidence of deficits varied with the type of test used to measure them. Most frequently, patients presented with both loss of two point as well as fine touch discrimination thresholds. Severe nerve injuries were associated with loss of temperature discrimination clinically and displaced fractures radiographically. There was no significant relationship between the recovery of pulpal and gingival sensation. The patterns of injury and recovery in ASAN and MSAN were similar. NSD after trauma to the maxillary antrum is relatively common. Clinical loss of temperature discrimination and radiographic signs of fracture lines passing through the canalis sinuosus are predictors of persistent and severe oral NSD.

SURGICAL TREATMENT OF AN ABNORMAL UPPER LABIAL FRENUM IN PEDIATRIC DENTISTRY

Introduction: The superior labial frenum corresponds to a thin and triangular anatomical structure that has its formation during the third month of intrauterine life, located from the tubercle of the upper lip to the alveolar process. Abnormal insertion of the roof-labial frenulum is usually indicated for surgical removal. If the surgical procedure is not performed, the frenum causes instability, the main problem being the diastema between the incisors, which many times cannot be treated only by orthodontics. The purpose of correction of the upper labial frenum consists of eliminating excess free tissue between the teeth, in addition to the purpose of improving aesthetics. Objective: To describe a case report of surgical treatment of the upper labial frenum performed on a pediatric patient at a Dental Specialties Center. Case report: Female patient, 11 years old, referred by the orthodontist with indication for surgical treatment of the upper labial frenum. On intraoral physical examination, the presence of persistent roof-labial frenum and diastema between the upper central incisors was observed. In view of the data obtained in the anamnesis and physical examination, we opted for the frenotomy technique with the repositioning of the brake. Intraoral antisepsis and facial antisepsis were performed, followed by terminal infiltrative anesthesia in the anterior superior alveolar nerves, bilaterally. Two oblique incisions were made close to the insertion of the roof-labial frenum and then the repositioning of the. Friction movements were performed between the incisors and simple stitches were used for suturing. After two weeks, the patient returned and the presence of tissue remnant was observed, which was removed using the same anesthetic technique and with the aid of Metzenbaum scissors, without the need for a new suture. Conclusion: Surgical treatments for labial frenum present excellent results and should be chosen according to the individual needs of each patient, always evaluating the risks, benefits and advantages and disadvantages.

FEATURES OF INCINAL ANESTHESIA IN THE TREATMENT OF ACUTE PERIODONTITIS OF THE FRONTAL TEETH OF MAXILLA IN ADOLESCENT CHILDREN

Actuality. Currently, the problem of treatment of acute forms of periodontitis, especially in children, is related to the use of anesthetic care against the background of increased stress factors and lability of the nervous system. The works of many authors have proven that after conducting incisor guide anesthesia, anesthesia occurs not only of the soft tissues of the anterior third of the palate, but also of the pulp of the incisors, which is especially important when extirpating the pulp and exposing the pulp chamber. Today, many authors recommend using incisive conductor anesthesia as a monomethod of pain relief for incisors, but this technique has not been widely used in practical health care. Some authors prove the effectiveness of the additional use of incisive conduction anesthesia when infiltration is insufficient. It should be noted that the data analysis has a contradictory character without the presence of a single dominant opinion regarding the combined method of using conductive and infiltration anesthesia, especially in adolescents with an odontogenic inflammatory process.
 The purpose of the study: to investigate the anesthetic effect with the combined use of infiltration and incisive conductor anesthesia in the treatment of acute periodontitis of the frontal group of teeth on the upper jaw in children of the adolescent period.
 Materials and methods. The archival data of cone-beam computed tomography of 25 patients on a Planmeca tomograph were studied. Outpatient treatment of 65 patients diagnosed with acute serous and acute purulent periodontitis was carried out. To anesthetize the central or lateral incisor from the side of the causative tooth, infiltration anesthesia with "Ultracain" (4% solution) was performed in the canine area of the maxilla, creating a depot of anesthetic 2-5 mm from the focus of inflammation and blocking the anterior upper alveolar nerves. The VAS (Visual Analog Scale) and the Numerical Rating Scale (NRS) were used to assess pain intensity.
 The results. According to the tomography results, we have found the following features: the incisive canal begins with two separate nasopalatine openings, which open in the front part of the bottom of the nasal cavity on both sides of the nasal septum, with the merging of the two canals into one incisive canal, which looks like a slingshot on the tomogram. The incisor foramen is located behind the central incisors of the upper jaw by 7-8 mm in girls and 8-9 mm in boys, immediately under the incisor papilla. Based on the results of X-ray studies, we established several forms of the channel. In 75-80% of cases, the incisive canal has the shape of an "eight", less often it is found in the form of a funnel and, in two cases, a cylinder. The length from the top of the incisive papilla to the narrowing of the incisive canal is 9.0-10.5 mm in girls and 10.0-11.7 mm in boys.
 In 58% of cases, on the tomogram, we have found the relationship between the alveolar canals and the incisive canal. At the level of the bottom of the nose, the microcanals of the anterior superior alveolar nerves connected with the incisor canal, in 22% of cases opening in the anterior third of the palate through independent openings. According to the obtained data, the combination of analgesia used allows the intervention to be completely painless in 82-87% of cases. In 4% of cases, patients complained of painful sensations, there was no need for additional analgesia. In 3% of cases (75% of cases in girls), endodontic treatment was painless, but at the same time, during the opening and drainage of the infiltrate in 5% of cases, additional infiltration anesthesia was performed. Immediately after incisive conduction anesthesia in 75% of cases, patients felt numbness of the nasal cavity, especially its lower third. When re-examining in 40% of cases, patients noted discomfort in the area of the incisor papilla.
 Conclusions. The use of a combination of infiltration anesthesia and incisive conductor anesthesia allows achieving full analgesia of the pulp and periodontal tissues in the treatment of acute periodontitis of the frontal group of teeth.

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.

GUIDED IMPLANT PLACEMENT ON EDENTULOUS MAXILLA TO AVOID DAMAGE TO ACCESSORY BRANCHES OF THE CANALIS SINUOSUS: A CASE REPORT

​Introduction The canalis sinuosus (CS) is an anatomical structure arising from the infraorbital nerve. It is a neuromuscular canal, carrying the anterior superior alveolar nerve and vessels. Rarely, accessory bilateral branches of CS are observed on cone beam computed tomography(CBCT) images, during implant planning, in the anterior maxilla region. It is an important anatomical structure often overlooked by surgeons and not visible by conventional radiographs. Case report A case of anatomical variation in the CS with accessory branches was detected after a CBCT was performed on an edentulous 72 years old male patient pre operatively for implant placement. On the examination of the axial slices of the CBCT, additional foramina lateral and anterior to the nasopalatine foramen were observed. By tracing into the bone from these foramina, it was observed that these accessory canals communicate with the CS. Implant planning was performed, respecting these canals and a surgical guide was fabricated, using the dual scan protocol from the patient’s denture. A post-op CBCT was performed to determine the accuracy of our guide and the position of the implants. No post-op complications were observed. Conclusion Several cases of intractable pain following implant placement in the anterior maxilla have been reported. Damage to the CS and its accessory canals may be the cause. Knowledge of these anatomical variations is of great importance and the use of guided implant placement is a useful tool to avoid iatrogenic surgical trauma and post-op surgical distress to the patient.

Canalis sinuosus approximation on an impacted maxillary canine: a case report

Objectives: This case report is aimed to report the finding of canalis sinuosus on an impacted maxillary canine using cone beam computed tomography (CBCT) examination.
 Case Report: A 21-year-old male was referred from orthodontic department to radiology department UNPAD Dental Hospital for CBCT to determine the treatment of malalignment asymptomatic maxillary canine. The case revealed the presence of canalis that was identified as a canalis sinuosus, a branch of the anterior superior alveolar nerve that rarely known by a practitioner, at the apex of impacted right maxillary canine.
 Conclusion: The information of this anatomical variation is important for professionals due to damage that may be caused during treatment. The use of advanced imaging examination is recommended to acknowledge the individual anatomical variation before determining the proper treatment planning.

Assessment of the anterior superior alveolar nerve and its impact on surgery of the lateral nasal wall.

The anterior superior alveolar nerve (ASAN) plays a major role in innervation of the lateral nasal wall. Its damage during nasal surgery can cause dental paraesthesia and numbness around the upper lip. Retrospective evaluation of the computed tomographic (CT) scans of 50 consecutive patients analysing 100 sides. We measured the mean distance from the shoulder of the inferior turbinate to the descending portion of the anterior superior alveolar nerve, to the anterior superior alveolar canal and the anterior-posterior distance between the 'shoulder' of the inferior turbinate and the pyriform aperture. The mean distance from the shoulder of the inferior turbinate to the descending portion of the anterior superior alveolar nerve was 6.4 ± 2.33 mm, with no difference between sides The mean relative height of the shoulder in relation to the anterior superior alveolar nerve canal was 4.78 ± 2.31mm with no significant difference between the two sides. The anterior-posterior distance between the 'shoulder' of inferior turbinate and the pyriform aperture was 6.96± 2.28mm, with no significant difference between the two sides. We found the anterior superior alveolar nerve to be a constant landmark in the lateral nasal wall. Therefore, the course of the ASAN should be assessed on a CT scan when a surgical approach through the pyriform aperture or anterior medial wall of the maxillary sinus is planned.

Classification of the Travel of the Anterior Superior Alveolar Nerve and Postoperative Symptoms in Endoscopic Modified Medial Maxillectomy

Classification of the Travel of the Anterior Superior Alveolar Nerve and Postoperative Symptoms in Endoscopic Modified Medial Maxillectomy

Cone beam computed tomography analysis of accessory canals of the canalis sinuosus: A prevalent but often overlooked anatomical variation in the anterior maxilla

Statement of problemAccessory canals of the canalis sinuosus, a bony canal carrying the anterior superior alveolar nerve and vessels, can often be present but overlooked in the anterior maxilla. Dental implant placement in this area may damage neurovascular branches if this anatomic variation is not carefully identified, resulting in unexpected complications. PurposeThe purpose of this retrospective study was to identify accessory canals of the canalis sinuosus and analyze their relationship to the terminal canalis sinuosus and anterior maxilla in Chinese patients to provide a warning for surgeons operating in the anterior maxilla. Material and methodsCone beam computed tomography (CBCT) scans of 1007 Chinese patients were examined to identify the prevalence and size of accessory canals with at least 1.0-mm diameter. Axial position of this canal was classified referring to the nasal cavity and adjacent teeth. Its sagittal position was determined by the distance from the bifurcation site of canalis sinuosus to the buccal alveolar crest and the distance from the canal opening to the palatal alveolar crest. Diameter of the terminal canalis sinuosus, distance from the terminal canalis sinuosus to the buccal alveolar crest, and anterior maxillary volume were measured on all scans. Binary logistic regression and the Spearman rank correlation coefficient were used for prevalence and diameter analysis. ResultsThe prevalence of the accessory canal was 36.9%, positively correlated the anterior maxillary volume (OR 1.408) and negatively correlated with the distance from the terminal canalis sinuosus to the buccal alveolar crest (OR 0.921). Average diameter of such canal was 1.1 ±0.1 mm, significantly higher in men, positively correlated with the diameter of terminal canalis sinuosus (rs=0.163) and the distance from the canal opening to the palatal alveolar crest (rs=0.192). All accessory canals started below the buccal cortical bone, 19.3 ±2.7 mm away from the buccal alveolar crest. There were 61.9% accessory canals opened between the central and the lateral incisors. Openings here and in the central incisor region were closer to the alveolar crest than that between the lateral incisor and the canine (P<.05). ConclusionsAccessory canals of the canalis sinuosus have high prevalence in the anterior maxilla in a Chinese population. Large anterior maxillary volume has been demonstrated as a risk factor associated with the presence of such canals. The region between the central and the lateral incisors was a predominant location. Openings in this region were closer to the alveolar crest than those between the lateral incisor and the canine.

Effectiveness of Anterior and Middle Superior Alveolar Nerve Block for Anesthesia of Maxillary Teeth Using Conventional Syringe: A Randomized Prospective Study.

To study the effectiveness of anterior and middle superior alveolar nerve block (AMSA) for anesthesia of unilateral maxillary teeth, i.e., from central incisor to second premolar of the same side by using conventional syringe and needle. Two hundred patients who needed extraction of any tooth/teeth in the region of central incisor to second premolar of the same side were randomly chosen for the study. Successful anesthesia was found in 71.5% of cases. However, the highest success rate was seen with first premolar (82.2%) and minimum with lateral incisor (67.5%), and induction time ranged from 6 to 12 min and duration for 30-45 min. Using conventional syringe and needle, AMSA can be administered to achieve adequate soft tissue anesthesia of maxillary central incisors, canine and premolars of that side and pulpal anesthesia to a good extent (more so with first premolar), without affecting the muscles of facial expressions and lip numbness, reducing the requirement of multiple injections for the same.

Effect of augmented reality simulation on administration of local anaesthesia in paediatric patients.

Augmented reality (AR) is a simulation of a three-dimensional environment created using hardware and software that provides the user with realistic experiences and ability to interact. The aim of the study was to evaluate the impact of AR simulator on the perception of learning and acute stress level in students administering local anaesthesia to paediatric patients relative to standard teaching methods. The prospective study included 21 fourth- and fifth-year students enrolled in 5-year dental programme. In addition to conventional training, the students of the study group used the augmented reality simulator in a dental office 2hours weekly in 2weeks. The level of salivary cortisol was measured before and after the anaesthetic procedure as one of the indicators of acute stress. A statistically significant shorter time to perform infiltrative anaesthesia technique for the anterior superior alveolar nerve was observed in students using the AR technique (28.91±9.06seconds in the study group and 39.80±9.29seconds in the control group). The level of cortisol before and after anaesthesia was statistically significant in all subjects (cortisol concentration was 0.53μg/dL before anaesthesia and 2.44μg/dL after the procedure); however, there was no statistically significant difference between the groups. The AR concept may influence better manipulation and control of the syringe in students administering their first anaesthetic injection to paediatric patients, but may not reduce acute stress.

Assesment of accessory branches of canalis sinuosus on CBCT images.

Background The aim of this study is to describe the presence, to reveal the frequency and characteristics of accessory canals (ACs) of the canalis sinuosus (CS) by cone beam computed tomography (CBCT). Material and Methods A total of 326 CBCT examinations were scanned retrospectively. The anatomical views were evaluated on sagittal, axial, coronal and cross sectional imaging. The following parameters were recorded: age, sex, presence or absence of ACs, location in relation to the adjacent teeth and distance to the nasal cavity floor (NCF), alveolar ridge crest (ARC) and buccal cortical bone (BCB), and incisive canal. All the collected data were statistically analyzed. Results 113 patients (34,7%); presented ACs in total 214 foramina of the sample. There were no statistically significant changes in the presence of ACs regarding age groups excluding 80-89 years. But there is a statistically significant difference regarding the frequency of ACs and the gender. The prevalence for male patients was higher than female patients. Curved-shape configuration of CS prevalence is found as 69,15%. The prevalence of vertical tracing is 26,16% and Y-shape configuration of CS prevalence is 4,67%. Diameter of the foramens of the CS branches was 1.30 mm. The mean distance of the AC to the NCF, BCB, and ARC were found 13,83 mm, 6,60 mm and 5,32 mm, respectively. Conclusions In the anterior palatal region, ACs are mostly related to CS’s branches. So; knowing the course of CS branches in surgical planning and radiographic evaluations in this region is extremely important for preventing complications and avoiding misdiagnosis. Key words:Anterior superior alveolar nerve, canalis sinuosus, maxilla.

Direct approach to the anterior and lateral part of the maxillary sinus with an endoscope

ObjectiveThe Caldwell-Luc (CL) approach with a sublabial incision is used to manipulate the anterior wall of the maxillary sinus. Paresthesia is one of the major complications associated with the CL approach. We developed a new method, “direct approach to the anterior and lateral part of the maxillary sinus with an endoscope” (DALMA), that negates the need for a sublabial incision and minimizes dental paresthesia by reducing the risk of anterior superior alveolar nerve injury. This study aimed to describe how to perform the DALMA technique, and to review its effectiveness and associated complications. MethodsWe retrospectively reviewed 10 patients who had received DALMA. ResultsTen patients underwent DALMA. The anterior superior alveolar nerve was identified in all patients. Access to the lateral side beyond the infraorbital canal and anterior wall of the maxillary sinus was achieved. ConclusionsDALMA is a simple, effective, and minimally invasive technique that can be used as an alternative to CL with sublabial incision.

Efficacy of the anterior and middle superior alveolar nerve block in achieving pulpal anesthesia of maxillary teeth

Introduction. The anterior and middle superior alveolar (AMSA) nerve block is an alternative technique of local anesthesia in the maxilla, unpredictably efficient for pulpal anesthesia. The aim of this study was to determine the anesthetic efficacy of the AMSA injection for pulpal anesthesia, using computer-controlled injection system or conventional syringe, and two local anesthetic solutions with or without adrenaline. Methods. The authors administered two AMSA injections during two separate appointments, utilizing the computer-controlled system and conventional syringe to 40 subjects, divided into two groups of 20 subjects each depending on the local anesthetic used. A pulp tester was used to test the achieved anesthesia of the central and lateral incisors, canine, first and second premolars, and the first molar in 10-minute cycles over a period of 60 minutes. Duration of anesthesia for all the mentioned teeth was also determined for both the anesthetic solutions and ways of application. Results. The AMSA injection with both types of equipment was successful, showing slow onset, satisfying intensity, and declining duration of pulpal anesthesia at the last two measurements. Local anesthetic with vasoconstrictor exhibited a significantly longer pulpal anesthesia. Conclusion. The AMSA nerve block could be recommended for achieving pulpal anesthesia of maxillary teeth from the region of the first incisor to the second premolar.

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.

Risk Assessment of Damage to the Anterior Superior Alveolar Nerve During Endoscopic Modified Medial Maxillectomy (EMMM)

Risk Assessment of Damage to the Anterior Superior Alveolar Nerve During Endoscopic Modified Medial Maxillectomy (EMMM)

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.