The Anesthetic Effect of Anterior Middle Superior Alveolar Technique
Condition: Periodontal Diseases; Local Anesthesia; Pain
MeSH terms: Periodontal Diseases
Study type: Interventional

Summary: 
      Anesthesia of the soft and hard tissues in the maxilla may require up to five injections.
      Thus, the aim of the present study was to evaluate the anesthetic efficacy in buccal tissues
      after the use of the anterior middle superior alveolar (AMSA) and supraperiosteal techniques
      during subgingival scaling and root planning (SRP).
    

Detailed description: 
      Patients with periodontal disease often have deep pockets that require scaling and root
      planing (SRP) and, hence, anesthesia of the periodontal tissues to control pain may be
      necessary. The proper anesthesia of the mucogingival tissues in the maxilla may need up to
      five injections of anesthetic solution. Thus, these various injections will anesthetize the
      (i) posterior superior alveolar, (ii) middle superior alveolar, (iii) anterior superior
      alveolar, (iv) greater palatine and (v) nasopalatine nerves. Although these series of
      anesthetic injections are effective to anesthetize the tissues of the jaw, they can reach
      other unwanted structures, such as the upper lip, the nostrils and lower eyelid, causing
      postoperative discomfort to the patient and minimizing the patient's ability to smile and
      show the top line of the lip.

      In order to minimize the side effects and allow a smaller number of punctures and amount of
      anesthetic solution used for control the pain in the maxilla, Friedman & Hochman (1998)
      described the anterior middle superior alveolar anesthetic technique (AMSA), for various
      dental procedures in the jaw. The AMSA has the ability to not anesthetize, undesirably, other
      anatomical structures beyond the periodontium and teeth such as upper lip, bridge of the nose
      and lower eyelid. This advantage occurs due to the fact that the anesthetic solution is
      administrated in a small location on the palate where it is not able to reach the sensory
      fibers of the lips and face and, therefore, does not alter the activity of the muscles that
      deal with facial expressions. In addition, the administration of only 0.6 to 0.9 ml of
      anesthetic, is able to induce anesthesia of the pulpal and soft tissues of the palate region.
      This is a significantly smaller amount of anesthetic than what is usually administered for
      the desired analgesia for dental and periodontal structures.

      The biological plausibility of the AMSA technique is due to the resilience of the tissues of
      the palate and the application of the anesthetic solution with controlled pressure and flow,
      so that it reaches the underlying bone and neurovascular anatomy. The penetration of the
      anesthetic in the tissues from the palate promotes the diffusion of the solution through
      numerous channels of nutrients and pores in the cortical bone of the palate4. With the spread
      of the anesthetic in the tissues, structures typically innervated by the anterior superior
      alveolar nerves, middle and posterior, nasopalatine and greater palatine are anesthetized.

      Several reports have suggested that this technique is effective to anesthetize teeth and
      maxillary tissues extending from the mesial root of first molar to central incisor with a
      single infiltration. However, there are no controlled studies in the literature that
      specifically evaluate the vestibular tissue analgesia, considering patient comfort during the
      procedure for scaling and root planing.

      Therefore, the aim of this study was to evaluate the anesthetic efficacy of AMSA technique of
      tissues at the buccal aspect of the ridge compared to conventional supraperiosteal techniques
      in the buccal area during the process of scaling and root planing of periodontal pockets in
      the jaw.
    

Intervention name(s): Anterior middle superior alveolar; Supraperiosteal technique
Intervention type(s): Procedure; Procedure
Intervention description(s): The AMSA technique is performed according to Friedman & Hochman (1997). The needle is introduced with the bevel towards the palate tissue with a 45 ° angle and axially rotated (45° clockwise/45° counterclockwise) and 0.6 ml of the anesthetic was slowly infiltrated for 1 minute. In the control group a supraperiosteal infiltration (infiltrative) at the bottom of the vestibule is performed for one minute and 1.8 ml of anesthetic solution is administrated. This amount of anesthetic is divided into doses of 0.6 ml infiltrated, respectively, in the region of the incisors, canines and premolars. After the anesthetic technique, two minutes would be expected for the beginning of the periodontal procedure.; The supraperiosteal technique is performed at the bottom of the vestibule for one minute and 1.8 ml of anesthetic solution is administrated. This amount of anesthetic is divided into doses of 0.6 ml infiltrated, respectively, in the region of the incisors, canines and premolars. After the anesthetic technique, two minutes would be expected for the beginning of the scaling and root planning procedure.
Other intervention name(s): Infiltrative technique
Allocation: Randomized
Intervention model: Single Group Assignment
Masking: Double (Participant, Outcomes Assessor)
Primary purpose: Treatment
Keywords: Treatment