The palatinal side anesthesia for the anterior and Middle branches of the Superior alveolar plexus as a primary technique in oral surgical interventions

Introduction: Anterior Middle Superior Anesthesia (AMSA) is considered a conductive technique for the first five maxillary teeth (from central incisors to the second premolar). This alternative anesthesia is considered a supplementary technique targeting the subneural dental plexus located near the root apices of the premolars. The study aimed to determine whether AMSA anesthesia technique can serve as a primary and independent method for extracting of the first five upper jaw teeth (incisors, canines, and premolars). Materials and methods: The study included 24 healthy patients allocated in the group I (received 4% articaine with adrenaline) and the group II (received lidocaine with adrenaline). The patients had avital maxillary teeth (from incisors to premolars). AMSA technique was used as primary anesthesia for extraction. The monitored anesthesia parameters included: pain perception during the application of anesthesia and the surgical procedure, overall success of anesthesia, onset time, and duration of anesthesia and post extraction complications. Results: The duration of anesthesia was 52±17,10 min in the first group, while it was 40,25±7,629 min (p=0,044). The level of pain during the extraction was 3,42± 1,73in the first group, while it was 5,25±2,41 in the second, with statistically significant difference between groups (p=0,046). The need for additional anesthesia was 2 (16,66%), in the first and 5 (41,66%). in the second group. Conclusion: The AMSA technique has demonstrated high efficacy for simple extractions when articaine is used; it shows less anesthetic efficacy when lidocaine is used. The AMSA anesthesia technique with articaine may be considered a primary local anesthesia technique for the extraction of the first five maxillary teeth when they are not vital.