title: Anterior middle superior alveolar injection is effective in providing anesthesia extending to the last standing molar in maxillary periodontal surgery.
abstract: BACKGROUND
  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.
  
  
  METHODS
  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.
  
  
  RESULTS
  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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Department of Periodontics, Sri Dharmasthala Manjunatheshwara College of Dental Sciences and Hospital, Dharwad, Karnataka, India. abacharya@gmail.com
authors.forename: Anirudh B
authors.initials: AB
authors.lastname: Acharya
authors.forename: Chetana
authors.initials: C
authors.lastname: Banakar
authors.forename: Silvia V
authors.initials: SV
authors.lastname: Rodrigues
authors.forename: Swati
authors.initials: S
authors.lastname: Nagpal
authors.forename: Smruti
authors.initials: S
authors.lastname: Bhadbhade
authors.forename: Srinath L
authors.initials: SL
authors.lastname: Thakur
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000766:Anesthesia, Dental / Q000379:methods; D000779:Anesthetics, Local / Q000008:administration & dosage; D003646:Debridement; D003724:Dental Arch / Q000294:innervation; D005260:Female; D005890:Gingivectomy; D006801:Humans; D007180:Incisor / Q000294:innervation; D007267:Injections / Q000295:instrumentation; D008012:Lidocaine / Q000008:administration & dosage; D008297:Male; D008437:Maxilla / Q000294:innervation; D008442:Maxillary Nerve / Q000187:drug effects; D008875:Middle Aged; D008963:Molar / Q000294:innervation*; D009061:Mouth Mucosa / Q000294:innervation; D009339:Needles; D009407:Nerve Block / Q000379:methods*; D010027:Osteotomy; D010159:Palate / Q000294:innervation; D010510:Periodontal Diseases / Q000601:surgery*; D013524:Surgical Flaps; D013997:Time Factors; D055815:Young Adult
chemical_list: D000779:Anesthetics, Local; D008012:Lidocaine