Journal of Dental Anesthesia and Pain Medicine

The Korean Dental Society of Anesthsiology (대한치과마취과학회)
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Pattern of buccal and palatal bone density in the maxillary premolar region: an anatomical basis of anterior-middle superior alveolar (AMSA) anesthetic technique

  • Ahad, Abdul (Department of Dentistry, Medini Rai Medical College) ;
  • Haque, Ekramul (Department of Periodontics, Dr. Ziauddin Ahmad Dental College, Faculty of Medicine, Aligarh Muslim University) ;
  • Naaz, Sabiha (Department of Periodontics, Dr. Ziauddin Ahmad Dental College, Faculty of Medicine, Aligarh Muslim University) ;
  • Bey, Afshan (Department of Periodontics, Dr. Ziauddin Ahmad Dental College, Faculty of Medicine, Aligarh Muslim University) ;
  • Rahman, Sajjad Abdur (Department of Oral and Maxillofacial Surgery, Dr. Ziauddin Ahmad Dental College, Faculty of Medicine, Aligarh Muslim University)
  • Received : 2020.09.09
  • Accepted : 2020.11.05
  • Published : 2020.12.31
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Abstract

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.

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References

  1. Loomer PM, Perry DA. Computer-controlled delivery versus syringe delivery of local anesthetic injections for therapeutic scaling and root planing. J Am Dent Assoc 2004; 135: 358-65. https://doi.org/10.14219/jada.archive.2004.0188
  2. Friedman MJ, Hochman MN. A 21st century computerized injection system for local pain control. Compend Contin Educ Dent 1997; 18: 995-1000.
  3. Hochman M, Chiarello D, Hochman CB, Lopatkin R, Pergola S. Computerized local anesthetic delivery vs. traditional syringe technique. NY State Dent J 1997; 63: 24-9.
  4. Iwanaga J, Tubbs RS. Palatal injection does not block the superior alveolar nerve trunks: correcting an error regarding the innervation of the maxillary teeth. Cureus 2018; 10: e2120.
  5. Cetkovic D, Antic S, Antonijevic D, Brkovic BMB, Djukic K, Vujaskovic G, et al. Nutrient canals and porosity of the bony palate: a basis for the biological plausibility of the anterior middle superior alveolar nerve block. J Am Dent Assoc 2018; 149: 859-68. https://doi.org/10.1016/j.adaj.2018.05.015
  6. Shapurian T, Damoulis PD, Reiser GM, Griffin TJ, Rand WM. Quantitative evaluation of bone density using the Hounsfield index. Int J Oral Maxillofac Implants 2006; 21: 290-7.
  7. Han S, Bayome M, Lee J, Lee YJ, Song HH, Kook YA. Evaluation of palatal bone density in adults and adolescents for application of skeletal anchorage devices. Angle Orthod 2012; 82: 625-31. https://doi.org/10.2319/071311-445.1
  8. Arora S, Lamba AK, Faraz F, Tandon S, Ahad A. Role of cone beam computed tomography in rehabilitation of a traumatised deficient maxillary alveolar ridge using symphyseal block graft placement. Case Rep Dent 2013; 2013: 748405. https://doi.org/10.1155/2013/748405
  9. Guerra ENS, Almeida FT, Bezerra FV, Figueiredo PTDS, Silva MAG, De Luca Canto G, et al. Capability of CBCT to identify patients with low bone mineral density: a systematic review. Dentomaxillofac Radiol 2017; 46: 20160475. https://doi.org/10.1259/dmfr.20160475
  10. Friedman MJ, Hochman MN. The AMSA injection: A new concept for local anesthesia of maxillary teeth using a computer - controlled injection system. Quintessence Int 1998; 29: 297-303.
  11. Acharya AB, Banakar C, Rodrigues SV, Nagpal S, Bhadbhade S, Thakur SL. Anterior middle superior alveolar injection is effective in providing anesthesia extending to the last standing molar in maxillary periodontal surgery. J Periodontol 2010; 81: 1174-9. https://doi.org/10.1902/jop.2010.100109
  12. Tomic S, Simic I, Stanojevic M, Jankovic S, Todorovic L. Anterior and middle superior alveolar block is efficient for maxillary premolar teeth extractions regardless of the injection system or anesthetic with adrenaline used. Srp Arh Celok Lek 2016; 144: 470-3. https://doi.org/10.2298/SARH1610470T
  13. Tandon S, Lamba AK, Faraz F, Aggarwal K, Ahad A, Yadav N. Effectiveness of anterior middle superior alveolar injection using a computer-controlled local anesthetic delivery system for maxillary periodontal flap surgery. J Dent Anesth Pain Med 2019; 19: 45-54. https://doi.org/10.17245/jdapm.2019.19.1.45
  14. Lee S, Reader A, Nusstein J, Beck M, Weaver J. Anesthetic efficacy of the anterior middle superior alveolar (AMSA) injection. Anesth Prog 2004; 51: 80-9.
  15. Velasco I, Soto R: Anterior and middle superior alveolar nerve block for anesthesia of maxillary teeth using conventional syringe. Dent Res J 2012; 9: 535-40. https://doi.org/10.4103/1735-3327.104870
  16. Ahad A, Haque E, Tandon S. Current status of the anterior middle superior alveolar anesthetic injection for periodontal procedures in the maxilla. J Dent Anesth Pain Med 2019; 19: 1-10. https://doi.org/10.17245/jdapm.2019.19.1.1
  17. Murakami G, Ohtsuka K, Sato I, Moriyama H, Shimada K, Tomita H. The superior alveolar nerves: their topographical relationship and distribution to the maxillary sinus in human adults. Okajimas Folia Anat Jpn 1994; 70: 319-28. https://doi.org/10.2535/ofaj1936.70.6_319
  18. Loetscher CA, Walton RE. Patterns of innervation of the maxillary first molar: a dissection study. Oral Surg Oral Med Oral Pathol 1988; 65: 86-90. https://doi.org/10.1016/0030-4220(88)90198-3
  19. McDaniel WL. Variations in nerve distributions of the maxillary teeth. J Dent Res 1956; 35: 916-21. https://doi.org/10.1177/00220345560350061301
  20. Ozdemir F, Tozlu M, Germec Cakan D. Quantitative evaluation of alveolar cortical bone density in adults with different vertical facial types using cone-beam computed tomography. Korean J Orthod. 2014; 44: 36-43. https://doi.org/10.4041/kjod.2014.44.1.36
  21. Park HS, Lee YJ, Jeong SH, Kwon TG. Density of the alveolar and basal bones of the maxilla and the mandible. Am J Orthod Dentofacial Orthop 2008; 133: 30-7. https://doi.org/10.1016/j.ajodo.2006.01.044
  22. Al-Attas MA, Koppolu P, Alanazi SA, Alduaji KT, Parameaswari PJ, Swapna LA, et al. Radiographic evaluation of bone density in dentulous and edentulous patients in Riyadh, KSA. Niger J Clin Pract 2020; 23: 258-65.
  23. Nackaerts O, Maes F, Yan H, Couto Souza P, Pauwels R, Jacobs R. Analysis of intensity variability in multislice and cone beam computed tomography. Clin Oral Implants Res 2011; 22: 873-9. https://doi.org/10.1111/j.1600-0501.2010.02076.x