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Photographs showing the anterior middle superior alveolar (AMSA) injection given using a conventional syringe with a 27-gauge needle (Septoject; Sofic, Mazamet, France) and a 2% lignocaine cartridge (Lignospan Special; Septodont, Saint-Maur-des-Fossés, France). (A) The site of AMSA injection. (B) Blanching of the palatal mucosa suggests the extent of anesthesia obtained using the AMSA injection.
Source publication
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 s...
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Background
Profound 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 effectivenes...
Citations
... Iwanga and Tubbs termed this technique an unnecessary anesthetic blockade based on erroneous morphology. However, a recent comprehensive review of seven published articles in which the AMSA technique was used for various periodontal procedures concluded that this technique offers significant advantages over conventional techniques despite having several limitations[16]. It was found to anesthetize the palatal hard and soft tissues consistently and was recommended to be considered as the first line of anesthesia for periodontal procedures in the maxilla[13,16]. ...
... However, a recent comprehensive review of seven published articles in which the AMSA technique was used for various periodontal procedures concluded that this technique offers significant advantages over conventional techniques despite having several limitations[16]. It was found to anesthetize the palatal hard and soft tissues consistently and was recommended to be considered as the first line of anesthesia for periodontal procedures in the maxilla[13,16]. Its advantages include but are not limited to the reduced cumulative number of injections and the total amount of vasoconstrictor delivered as well as maintenance of upper lip movement allowing the continuous evaluation of gingival contours unaffected by lip drooping. This technique could also provide an alternative option whenever local anesthesia cannot be administered successfully through the buccal aspect, such as the presence of a large abscess or a neoplastic lesion in the buccal vestibule or reduced mouth opening due to various reasons. ...
Background: The 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.
Method: Cone-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.
Results: Cancellous 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.
Conclusions: The 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.
