J Dent Anesth Pain Med.  2019 Feb;19(1):45-54. 10.17245/jdapm.2019.19.1.45.

Effectiveness of anterior middle superior alveolar injection using a computer-controlled local anesthetic delivery system for maxillary periodontal flap surgery

• Tandon S
• Lamba AK
• Faraz F
• Aggarwal K
• Ahad A
• Yadav N

• KMID: 2439035
• DOI: http://doi.org/10.17245/jdapm.2019.19.1.45

Abstract

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 effectiveness of AMSA injection using computer-controlled local anesthetic delivery (CCLAD) system to anesthetize buccal hard tissue (BHT), buccal soft tissue (BST), palatal hard tissue (PHT), and palatal soft tissue (PST) around the maxillary teeth.
METHODS
Thirty-five patients who were indicated for open flap debridement in a whole maxillary quadrant were given AMSA injection using the CCLAD. The effectiveness of anesthesia was evaluated using subjective and objective parameters around each tooth. Supraperiosteal infiltrations were administered to complete the surgery wherever the AMSA injection was ineffective.
RESULTS
The AMSA injection was more effective on the palatal tissues than on the buccal tissues, as 94.14% of PST and 87.89% of PHT sites were anesthetized compared to 49.22% and 43.75% of BHT and BST sites, respectively. There was no significant difference in the frequency of anesthesia around the anterior and posterior teeth. The PHT was significantly more anesthetized (P = 0.003) in males than in females.
CONCLUSIONS
The AMSA injection using CCLAD is highly effective on palatal tissues and could be used as a first-line anesthesia for periodontal flap surgery. However, its effect on buccal tissues is less predictable, with supraperiosteal infiltration often required to supplement the AMSA injection.

Keyword

Local Anesthetics; Maxilla; Pain; Palate; Periodontal Debridement

MeSH Terms

Amsacrine
Anesthesia
Anesthetics, Local
Butylated Hydroxytoluene
Debridement
Female
Humans
Male
Maxilla
Palate
Periodontal Debridement
Tooth
Amsacrine
Anesthetics, Local
Butylated Hydroxytoluene

Figure

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  Fig. 1 An outline of the sample selection process

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  Fig. 2 Delivery of AMSA injection using the CCLAD system

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  Fig. 3 Blanching of the palatal mucosa crossed the mid-palatine raphe in some cases.

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  Fig. 4 Percentage of sites anesthetized around different teeth in the maxillary quadrant. BHT: buccal hard tissue, BST: buccal soft tissue, PHT: palatal hard tissue, PST: palatal soft tissue

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