For over a decade of introducing the anterior middle superior alveolar (AMSA) injection, it has since majorly only been reported to show both pulpal and buccal mucosal effectiveness using a minimum of 0.9 ml of anesthetic solution.

The aim of this study was to demonstrate the AMSA nerve block efficacy using a reduced dosage and conventional syringe, while comparing the anesthetic effectiveness of lidocaine vs mepivacaine. A primary objective was to understand the behavioral difference between the two solutions, to better adapt their application into relevant clinical scenarios, where fewer injections are administered, pain control is better understood and implemented, and collateral anesthesia altering the natural lip line is eliminated.

Twelve candidates (both sexes), of ages 18 to 24, were selected. All the participants received bilateral AMSA nerve block (split-mouth technique) using the conventional syringe, where 0.6 ml of lidocaine and mepivacaine 2% with epinephrine 1:100,000 were randomly administered to each side.

Pulpal anesthesia on both premolar teeth showed 83.3% success within 15 minutes with lidocaine group (LG) and mepivacaine group (MG) alike. Buccal anesthesia at both premolar teeth showed 50% success within 15 minutes with LG and 54.2% with MG. There was no difference in anesthetic effectiveness between the two groups in pulpal anesthesia (p ≥0.05), and no significant difference in buccal mucosal anesthesia (p ≥0.05).

No statistically significant difference was observed between lidocaine and mepivacaine, while both expressed anesthetic effectiveness using a reduced dosage, as well as near painlessness using the conventional syringe.

Tattan M, Kokovic V. Anterior Middle Superior Alveolar Nerve Block Efficacy Utilizing different Anesthetic Solutions, Reduced Dosage and Conventional Syringe: A Breakthrough in Pain Control. Int J Experiment Dent Sci 2015;4(2):80-86.