title: Alternative anesthetic technique for maxillary periodontal surgery.
abstract: BACKGROUND
  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.
  
  
  METHODS
  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.
  
  
  RESULTS
  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.
  
  
  CONCLUSIONS
  The AMSA injection is a novel anesthetic technique that may prove useful for certain maxillary periodontal surgeries.
authors.affiliation: Department of Periodontics-U.S. Navy, Naval Hospital Pensacola, 450 Turner Street, Pensacola, FL 32508, USA.
authors.forename: Dan
authors.initials: D
authors.lastname: Holtzclaw
authors.forename: Nicholas
authors.initials: N
authors.lastname: Toscano
mesh_terms: D000328:Adult; D016301:Alveolar Bone Loss / Q000601:surgery; D000539:Alveolar Process / Q000294:innervation; D000540:Alveolar Ridge Augmentation; D000543:Alveoloplasty; D000766:Anesthesia, Dental / Q000379:methods*; D000779:Anesthetics, Local / Q000008:administration & dosage*; D016556:Crown Lengthening; D005260:Female; D005889:Gingival Recession / Q000601:surgery; D006489:Hemostatic Techniques; D006801:Humans; D007267:Injections / Q000295:instrumentation / Q000379:methods; D008297:Male; D008437:Maxilla / Q000294:innervation / Q000601:surgery*; D008875:Middle Aged; D010159:Palate / Q000294:innervation; D010518:Periodontitis / Q000601:surgery; D010519:Periodontium / Q000294:innervation / Q000601:surgery*; D013524:Surgical Flaps; D014095:Tooth, Impacted / Q000601:surgery; D014096:Tooth, Supernumerary / Q000601:surgery
chemical_list: D000779:Anesthetics, Local