Journal of Clinical and Diagnostic Research, ISSN - 0973 - 709X

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Dr Bhanu K Bhakhri

"The Journal of Clinical and Diagnostic Research (JCDR) has been in operation since almost a decade. It has contributed a huge number of peer reviewed articles, across a spectrum of medical disciplines, to the medical literature.
Its wide based indexing and open access publications attracts many authors as well as readers
For authors, the manuscripts can be uploaded online through an easily navigable portal, on other hand, reviewers appreciate the systematic handling of all manuscripts. The way JCDR has emerged as an effective medium for publishing wide array of observations in Indian context, I wish the editorial team success in their endeavour"



Dr Bhanu K Bhakhri
Faculty, Pediatric Medicine
Super Speciality Paediatric Hospital and Post Graduate Teaching Institute, Noida
On Sep 2018




Dr Mohan Z Mani

"Thank you very much for having published my article in record time.I would like to compliment you and your entire staff for your promptness, courtesy, and willingness to be customer friendly, which is quite unusual.I was given your reference by a colleague in pathology,and was able to directly phone your editorial office for clarifications.I would particularly like to thank the publication managers and the Assistant Editor who were following up my article. I would also like to thank you for adjusting the money I paid initially into payment for my modified article,and refunding the balance.
I wish all success to your journal and look forward to sending you any suitable similar article in future"



Dr Mohan Z Mani,
Professor & Head,
Department of Dematolgy,
Believers Church Medical College,
Thiruvalla, Kerala
On Sep 2018




Prof. Somashekhar Nimbalkar

"Over the last few years, we have published our research regularly in Journal of Clinical and Diagnostic Research. Having published in more than 20 high impact journals over the last five years including several high impact ones and reviewing articles for even more journals across my fields of interest, we value our published work in JCDR for their high standards in publishing scientific articles. The ease of submission, the rapid reviews in under a month, the high quality of their reviewers and keen attention to the final process of proofs and publication, ensure that there are no mistakes in the final article. We have been asked clarifications on several occasions and have been happy to provide them and it exemplifies the commitment to quality of the team at JCDR."



Prof. Somashekhar Nimbalkar
Head, Department of Pediatrics, Pramukhswami Medical College, Karamsad
Chairman, Research Group, Charutar Arogya Mandal, Karamsad
National Joint Coordinator - Advanced IAP NNF NRP Program
Ex-Member, Governing Body, National Neonatology Forum, New Delhi
Ex-President - National Neonatology Forum Gujarat State Chapter
Department of Pediatrics, Pramukhswami Medical College, Karamsad, Anand, Gujarat.
On Sep 2018




Dr. Kalyani R

"Journal of Clinical and Diagnostic Research is at present a well-known Indian originated scientific journal which started with a humble beginning. I have been associated with this journal since many years. I appreciate the Editor, Dr. Hemant Jain, for his constant effort in bringing up this journal to the present status right from the scratch. The journal is multidisciplinary. It encourages in publishing the scientific articles from postgraduates and also the beginners who start their career. At the same time the journal also caters for the high quality articles from specialty and super-specialty researchers. Hence it provides a platform for the scientist and researchers to publish. The other aspect of it is, the readers get the information regarding the most recent developments in science which can be used for teaching, research, treating patients and to some extent take preventive measures against certain diseases. The journal is contributing immensely to the society at national and international level."



Dr Kalyani R
Professor and Head
Department of Pathology
Sri Devaraj Urs Medical College
Sri Devaraj Urs Academy of Higher Education and Research , Kolar, Karnataka
On Sep 2018




Dr. Saumya Navit

"As a peer-reviewed journal, the Journal of Clinical and Diagnostic Research provides an opportunity to researchers, scientists and budding professionals to explore the developments in the field of medicine and dentistry and their varied specialities, thus extending our view on biological diversities of living species in relation to medicine.
‘Knowledge is treasure of a wise man.’ The free access of this journal provides an immense scope of learning for the both the old and the young in field of medicine and dentistry as well. The multidisciplinary nature of the journal makes it a better platform to absorb all that is being researched and developed. The publication process is systematic and professional. Online submission, publication and peer reviewing makes it a user-friendly journal.
As an experienced dentist and an academician, I proudly recommend this journal to the dental fraternity as a good quality open access platform for rapid communication of their cutting-edge research progress and discovery.
I wish JCDR a great success and I hope that journal will soar higher with the passing time."



Dr Saumya Navit
Professor and Head
Department of Pediatric Dentistry
Saraswati Dental College
Lucknow
On Sep 2018




Dr. Arunava Biswas

"My sincere attachment with JCDR as an author as well as reviewer is a learning experience . Their systematic approach in publication of article in various categories is really praiseworthy.
Their prompt and timely response to review's query and the manner in which they have set the reviewing process helps in extracting the best possible scientific writings for publication.
It's a honour and pride to be a part of the JCDR team. My very best wishes to JCDR and hope it will sparkle up above the sky as a high indexed journal in near future."



Dr. Arunava Biswas
MD, DM (Clinical Pharmacology)
Assistant Professor
Department of Pharmacology
Calcutta National Medical College & Hospital , Kolkata




Dr. C.S. Ramesh Babu
" Journal of Clinical and Diagnostic Research (JCDR) is a multi-specialty medical and dental journal publishing high quality research articles in almost all branches of medicine. The quality of printing of figures and tables is excellent and comparable to any International journal. An added advantage is nominal publication charges and monthly issue of the journal and more chances of an article being accepted for publication. Moreover being a multi-specialty journal an article concerning a particular specialty has a wider reach of readers of other related specialties also. As an author and reviewer for several years I find this Journal most suitable and highly recommend this Journal."
Best regards,
C.S. Ramesh Babu,
Associate Professor of Anatomy,
Muzaffarnagar Medical College,
Muzaffarnagar.
On Aug 2018




Dr. Arundhathi. S
"Journal of Clinical and Diagnostic Research (JCDR) is a reputed peer reviewed journal and is constantly involved in publishing high quality research articles related to medicine. Its been a great pleasure to be associated with this esteemed journal as a reviewer and as an author for a couple of years. The editorial board consists of many dedicated and reputed experts as its members and they are doing an appreciable work in guiding budding researchers. JCDR is doing a commendable job in scientific research by promoting excellent quality research & review articles and case reports & series. The reviewers provide appropriate suggestions that improve the quality of articles. I strongly recommend my fraternity to encourage JCDR by contributing their valuable research work in this widely accepted, user friendly journal. I hope my collaboration with JCDR will continue for a long time".



Dr. Arundhathi. S
MBBS, MD (Pathology),
Sanjay Gandhi institute of trauma and orthopedics,
Bengaluru.
On Aug 2018




Dr. Mamta Gupta,
"It gives me great pleasure to be associated with JCDR, since last 2-3 years. Since then I have authored, co-authored and reviewed about 25 articles in JCDR. I thank JCDR for giving me an opportunity to improve my own skills as an author and a reviewer.
It 's a multispecialty journal, publishing high quality articles. It gives a platform to the authors to publish their research work which can be available for everyone across the globe to read. The best thing about JCDR is that the full articles of all medical specialties are available as pdf/html for reading free of cost or without institutional subscription, which is not there for other journals. For those who have problem in writing manuscript or do statistical work, JCDR comes for their rescue.
The journal has a monthly publication and the articles are published quite fast. In time compared to other journals. The on-line first publication is also a great advantage and facility to review one's own articles before going to print. The response to any query and permission if required, is quite fast; this is quite commendable. I have a very good experience about seeking quick permission for quoting a photograph (Fig.) from a JCDR article for my chapter authored in an E book. I never thought it would be so easy. No hassles.
Reviewing articles is no less a pain staking process and requires in depth perception, knowledge about the topic for review. It requires time and concentration, yet I enjoy doing it. The JCDR website especially for the reviewers is quite user friendly. My suggestions for improving the journal is, more strict review process, so that only high quality articles are published. I find a a good number of articles in Obst. Gynae, hence, a new journal for this specialty titled JCDR-OG can be started. May be a bimonthly or quarterly publication to begin with. Only selected articles should find a place in it.
An yearly reward for the best article authored can also incentivize the authors. Though the process of finding the best article will be not be very easy. I do not know how reviewing process can be improved. If an article is being reviewed by two reviewers, then opinion of one can be communicated to the other or the final opinion of the editor can be communicated to the reviewer if requested for. This will help one’s reviewing skills.
My best wishes to Dr. Hemant Jain and all the editorial staff of JCDR for their untiring efforts to bring out this journal. I strongly recommend medical fraternity to publish their valuable research work in this esteemed journal, JCDR".



Dr. Mamta Gupta
Consultant
(Ex HOD Obs &Gynae, Hindu Rao Hospital and associated NDMC Medical College, Delhi)
Aug 2018




Dr. Rajendra Kumar Ghritlaharey

"I wish to thank Dr. Hemant Jain, Editor-in-Chief Journal of Clinical and Diagnostic Research (JCDR), for asking me to write up few words.
Writing is the representation of language in a textual medium i e; into the words and sentences on paper. Quality medical manuscript writing in particular, demands not only a high-quality research, but also requires accurate and concise communication of findings and conclusions, with adherence to particular journal guidelines. In medical field whether working in teaching, private, or in corporate institution, everyone wants to excel in his / her own field and get recognised by making manuscripts publication.


Authors are the souls of any journal, and deserve much respect. To publish a journal manuscripts are needed from authors. Authors have a great responsibility for producing facts of their work in terms of number and results truthfully and an individual honesty is expected from authors in this regards. Both ways its true "No authors-No manuscripts-No journals" and "No journals–No manuscripts–No authors". Reviewing a manuscript is also a very responsible and important task of any peer-reviewed journal and to be taken seriously. It needs knowledge on the subject, sincerity, honesty and determination. Although the process of reviewing a manuscript is a time consuming task butit is expected to give one's best remarks within the time frame of the journal.
Salient features of the JCDR: It is a biomedical, multidisciplinary (including all medical and dental specialities), e-journal, with wide scope and extensive author support. At the same time, a free text of manuscript is available in HTML and PDF format. There is fast growing authorship and readership with JCDR as this can be judged by the number of articles published in it i e; in Feb 2007 of its first issue, it contained 5 articles only, and now in its recent volume published in April 2011, it contained 67 manuscripts. This e-journal is fulfilling the commitments and objectives sincerely, (as stated by Editor-in-chief in his preface to first edition) i e; to encourage physicians through the internet, especially from the developing countries who witness a spectrum of disease and acquire a wealth of knowledge to publish their experiences to benefit the medical community in patients care. I also feel that many of us have work of substance, newer ideas, adequate clinical materials but poor in medical writing and hesitation to submit the work and need help. JCDR provides authors help in this regards.
Timely publication of journal: Publication of manuscripts and bringing out the issue in time is one of the positive aspects of JCDR and is possible with strong support team in terms of peer reviewers, proof reading, language check, computer operators, etc. This is one of the great reasons for authors to submit their work with JCDR. Another best part of JCDR is "Online first Publications" facilities available for the authors. This facility not only provides the prompt publications of the manuscripts but at the same time also early availability of the manuscripts for the readers.
Indexation and online availability: Indexation transforms the journal in some sense from its local ownership to the worldwide professional community and to the public.JCDR is indexed with Embase & EMbiology, Google Scholar, Index Copernicus, Chemical Abstracts Service, Journal seek Database, Indian Science Abstracts, to name few of them. Manuscriptspublished in JCDR are available on major search engines ie; google, yahoo, msn.
In the era of fast growing newer technologies, and in computer and internet friendly environment the manuscripts preparation, submission, review, revision, etc and all can be done and checked with a click from all corer of the world, at any time. Of course there is always a scope for improvement in every field and none is perfect. To progress, one needs to identify the areas of one's weakness and to strengthen them.
It is well said that "happy beginning is half done" and it fits perfectly with JCDR. It has grown considerably and I feel it has already grown up from its infancy to adolescence, achieving the status of standard online e-journal form Indian continent since its inception in Feb 2007. This had been made possible due to the efforts and the hard work put in it. The way the JCDR is improving with every new volume, with good quality original manuscripts, makes it a quality journal for readers. I must thank and congratulate Dr Hemant Jain, Editor-in-Chief JCDR and his team for their sincere efforts, dedication, and determination for making JCDR a fast growing journal.
Every one of us: authors, reviewers, editors, and publisher are responsible for enhancing the stature of the journal. I wish for a great success for JCDR."



Thanking you
With sincere regards
Dr. Rajendra Kumar Ghritlaharey, M.S., M. Ch., FAIS
Associate Professor,
Department of Paediatric Surgery, Gandhi Medical College & Associated
Kamla Nehru & Hamidia Hospitals Bhopal, Madhya Pradesh 462 001 (India)
E-mail: drrajendrak1@rediffmail.com
On May 11,2011




Dr. Shankar P.R.

"On looking back through my Gmail archives after being requested by the journal to write a short editorial about my experiences of publishing with the Journal of Clinical and Diagnostic Research (JCDR), I came across an e-mail from Dr. Hemant Jain, Editor, in March 2007, which introduced the new electronic journal. The main features of the journal which were outlined in the e-mail were extensive author support, cash rewards, the peer review process, and other salient features of the journal.
Over a span of over four years, we (I and my colleagues) have published around 25 articles in the journal. In this editorial, I plan to briefly discuss my experiences of publishing with JCDR and the strengths of the journal and to finally address the areas for improvement.
My experiences of publishing with JCDR: Overall, my experiences of publishing withJCDR have been positive. The best point about the journal is that it responds to queries from the author. This may seem to be simple and not too much to ask for, but unfortunately, many journals in the subcontinent and from many developing countries do not respond or they respond with a long delay to the queries from the authors 1. The reasons could be many, including lack of optimal secretarial and other support. Another problem with many journals is the slowness of the review process. Editorial processing and peer review can take anywhere between a year to two years with some journals. Also, some journals do not keep the contributors informed about the progress of the review process. Due to the long review process, the articles can lose their relevance and topicality. A major benefit with JCDR is the timeliness and promptness of its response. In Dr Jain's e-mail which was sent to me in 2007, before the introduction of the Pre-publishing system, he had stated that he had received my submission and that he would get back to me within seven days and he did!
Most of the manuscripts are published within 3 to 4 months of their submission if they are found to be suitable after the review process. JCDR is published bimonthly and the accepted articles were usually published in the next issue. Recently, due to the increased volume of the submissions, the review process has become slower and it ?? Section can take from 4 to 6 months for the articles to be reviewed. The journal has an extensive author support system and it has recently introduced a paid expedited review process. The journal also mentions the average time for processing the manuscript under different submission systems - regular submission and expedited review.
Strengths of the journal: The journal has an online first facility in which the accepted manuscripts may be published on the website before being included in a regular issue of the journal. This cuts down the time between their acceptance and the publication. The journal is indexed in many databases, though not in PubMed. The editorial board should now take steps to index the journal in PubMed. The journal has a system of notifying readers through e-mail when a new issue is released. Also, the articles are available in both the HTML and the PDF formats. I especially like the new and colorful page format of the journal. Also, the access statistics of the articles are available. The prepublication and the manuscript tracking system are also helpful for the authors.
Areas for improvement: In certain cases, I felt that the peer review process of the manuscripts was not up to international standards and that it should be strengthened. Also, the number of manuscripts in an issue is high and it may be difficult for readers to go through all of them. The journal can consider tightening of the peer review process and increasing the quality standards for the acceptance of the manuscripts. I faced occasional problems with the online manuscript submission (Pre-publishing) system, which have to be addressed.
Overall, the publishing process with JCDR has been smooth, quick and relatively hassle free and I can recommend other authors to consider the journal as an outlet for their work."



Dr. P. Ravi Shankar
KIST Medical College, P.O. Box 14142, Kathmandu, Nepal.
E-mail: ravi.dr.shankar@gmail.com
On April 2011

Important Notice

Dentistry
Year : 2011 | Month : June | Volume : 5 | Issue : 3 | Page : 675 - 678

AMSA (Anterior Middle Superior Alveolar) Injection: A Boon To Maxillary Periodontal Surger

MOHAMMED NAZISH ALAM,S.C.CHANDRASEKARAN,MOHAN.V,ANITHA Balaji

PG Student,Dept of Periodontics&Implantology Sree Balaji Dental college Chenni,Tamil Nadu dr.naz.ish.alam@gmail.com Phone No:09884325366

Correspondence Address :
PG Student,Dept of Periodontics&Implantology Sree Balaji Dental college Chenni,Tamil Nadu dr.naz.ish.alam@gmail.com Phone No:09884325366

Abstract

Introduction: Local anesthetics have been in use in dental practice for more than 100 years. The advent of local anesthetics with the development of nerve blockade injection techniques heralded a new era of patient comfort while permitting more extensive and invasive dental procedures.

Discussion: Today’s availability of a variety of local anesthetic agents enables dentists to select an anesthetic that possesses specific properties such as time of onset and duration, hemostatic control and degree of cardiac side effects that are appropriate foreach individual patient and for each specific dental procedure. The ease of the technique is its advantage and disadvantage should always be considered before its acceptance.

Conclusion: The importance of this review was to bring about awareness among the general clinician who have to use multiple injection for any treatment to be performed in the maxillary arch. The non compliance of the treatment on the maxillary arch is usually due to these factors. Hence introducing this technique can help patient compliance as well ease for the clinician. Also the duration of treatment is reduced.

Keywords

Articaine, Flap surgery, Anterior Middle Superior

Maxillary mucogingival or flap surgery usually requires up to five injections to obtain anesthesia of the hard and soft tissues. Posterior superior alveolar, middle superior alveolar, and anterior superior alveolar block injections are used to anesthetize buccal tissues, whereas greater palatine and nasopalatine blocks are used for palatal anesthesia. Although this series of injections effectively anesthetizes maxillary tissues it may also inadvertently affect facial structures such as the upper lip, lateral aspect of the nose, and lower eyelid (1)(2).

The palatal soft tissue anesthesia is achieved without numbness to the lips and face or interference with the muscles of facial expression. A bilateral AMSA injection supposedly anesthetizes 10 maxillary teeth extending from the second premolar on one side to the second premolar on the opposite side (3).

The AMSA injection derives its name from the injection’s ability to supposedly anesthetize both the anterior and middle superior alveolar nerves (4).

The middle superior alveolar (MSA) and anterior superior alveolar (ASA) nerves branch from the infraorbital nerve before they exit from the infraorbital foramen. The middle superior alveolar nerve is thought to innervate the maxillary premolars and plays some role in pulpal innervation of the mesiobuccal root of the first molar. The anterior superior alveolar nerve provides pulpal innervation to the central and lateral incisors and canines (5). The plexus where both nerves join is the target site for the AMSA injection (6).

ATRICAINE
Articaine is an analogue of prilocaine in which the benzene ring moiety found in all other amide local anesthetics has been replaced with a thiophene ring. To date, only one formulation has been approved in the United States, a 4% solution with 1:100,000 epinephrine. With a higher per-cartridge unit cost and a pulpal anesthesia duration of approximately one hour with soft-tissue anesthesia for two to four hours, it would initially appear that articaine is a less attractive agent for dental applications. However, with a slightly faster onset of action (1.4 to 3.6 minutes), reports of a longer and perhaps moreprofound level of anesthesia and most notably frequent practitioner anecdotes of a greater ability to diffuse through tissues, articaine has become a very widely used anesthetic agent in developed countries. The tissue diffusion characteristics of articaine are not well-understood. However, in a variable percentage of patients, a maxillary infiltration injection in the buccal vestibule will result in adequate palatal anesthesia for tooth extraction.

The Maxilla
Most problems with maxillary anesthesia can be attributed to individual variances of normal anatomical nerve pathways through the maxillary bone (7). While the pulpal sensory fibers of the maxillary teeth are primarily carried in the anterior, middle and posterior superior alveolar nerves, which also supply the buccal soft tissues, accessory pulpal innervation fibers may be found in the palatal innervations supplied by the nasopalatine and greater palatine nerves (7). By careful application of topical anesthetics, distraction techniques (application of pressure and/or vibration) and slow delivery of the anesthetic agent, palatal injections can be given with very little to no patient discomfort. With the availability of articaine hydrochloride 4% with epinephrine many practitioners are finding that palatal injections may not be necessary when it is injected into the maxillary buccal vestibule (8). Additionally, new computer-controlled anesthetic delivery systems are particularly at eliminating or at least minimizing, the discomfort of palatal injections (9),(10),(11).

Anesthetize Pati ent (Difficulties)
Many factors may affect the success of local anesthesia, some within the practitioner’s control and some clearly not. While no single technique will be successful for every patient, guidelines exist that can help reduce the incidence of failure. A failure will be defined as inadequate depth and/or duration of anesthesia to begin or to continue a dental procedure. Due to a number of factors, such as thicker cortical plates, a denser trabecular pattern, larger, more myelin(lipid)-rich nerve bundles, and more variable innervation pathways [12-19], more problems of inadequate anesthesia occur in the mandibular arch than in the maxillary. Although failures are more common in the mandibular arch, maxillary failures do occur and can be equally frustrating. Another concern is the situationwhere anesthesia of all apparent nerve pathways is achieved but the duration is short and/or the depth of anesthesia is poor. Giving a second injection into the same site as the first injection may prove adequate simply due to the increased volume of anesthetic solution. However, using a different anesthetic agent for the second injection may increase the likelihood of successful duration. This difference may be explained by individual variances in tissue pH conditions and differing characteristics of each anesthetic agent such as dissociation characteristics, lipid solubilities and receptor site protein-binding affinities. No contraindication exists for using any of the amide anesthetic agents in combination with one another. However, care must be taken to limit the total dosage of anesthetic given to the maximum amount allowable for the agent with the lowest permissible dosage.

Technique for Anesthesia
Malamed described the injection site to be on the hard palate about halfway along an imaginary line connecting the mid-palatal suture to the free gingival margin as shown in [Table/Fig 3&4]. Another description of the injection site is that it is located on the hard palate (Table/Fig 1) at the intersection of a vertical line bisecting the premolars and a horizontal line halfway between the mid-palatine raphe and the crest of the free gingival margin (20).

To avoid patient discomfort due to the tightly bound nature of the palatal tissue, the anesthetic agent should be injected into the site at a methodic rate of 0.5 ml per minute (3). Slow deposition of the anesthetic agent, the bound nature of the palatal tissue promotes diffusion of the anesthetic agent through the palatal bone via numerous nutrient canals (3). A successful AMSA injection typically blanches the palatal tissue in a unilateral fashion that does not cross the midline (21). Anesthesia of structures typically innervated by the greater palatine nerve, nasopalatine nerve, anterior superior alveolar nerve and middle superior alveolar nerve is achieved (22),(23),(24). A conventional syringe with a 27-gauge needle was used to deliver one carpule of 4% articaine with 1:100,000 epinephrine to the right palate via the AMSA injection over 4 minutes (25). Depositing a sufficient volume of the local anesthetic allows it to diffuse through the nutrient canals (Table/Fig 1) and porous cortical bone to envelope the concentrated subneural dental plexus at this location (1). It is also speculated that due to resiliency of palatal tissue, the anesthetic solution reaches the underlying bone and neuro-vasculature anatomy (7). It is the bound quality of the palatal tissue which promotes the diffusion of the anesthetic agent through the palatal bone via numerous nutrient canals (Table/Fig 1] (23).

ADVANTAGE (25)
The ability of the AMSA injection to cover large maxillary surgical fields provides multiple benefits because it reduces the cumulative number of necessary injections (Fig2) .

The elimination of repetitive transmucosal punctures, the elimination of multiple injections reduces the total amount of delivered vasoconstrictor and may prove useful for cardiovascular-compromised patients requiring maxillary anesthesia.

For maxillary anterior esthetic procedures, the AMSA’s maintenance of upper lip function allows for continuous evaluation of gingivalcontours unimpeded by the ‘‘lip drooping’’ that typically occurs with traditional anesthetic techniques.

Maxillary mucogingival procedures, the AMSA’s palatal delivery of a full carpule of anesthetic with vasoconstrictor provides outstanding hemostasis and reduces the need for multiple re-injections to attain hemostatic control during graft harvest.

The AMSA injection anesthetizes the buccal tissues from the palatal aspect, no vasoconstrictor affects the buccal gingiva and outstanding blood supply is maintained for nourishment of the connective tissue graft.

DISADVANTAGES (25)
The use of a computer-assisted injection system is recommended as the best method for administering AMSA injections. The added cost of this anesthetic delivery system is one potential drawback of the AMSA injection.

The long administration time. Some patients may find it disconcerting to have an injection last 4 minutes, and attempts to speed up the AMSA injection may lead to increased patient discomfort at the injection site.

The reduction of cumulative anesthetic vasoconstrictor, may also prove to be problematic for certain surgical procedures.

The reduction in vasoconstrictor proves beneficial forcardiovascular- compromised patients, it may lead to less than desirable hemostatic control.

The AMSA eliminates the need for multiple injections, less vasoconstrictor enters the buccal tissues, and a subsequent decline in hemostasis may obscure portions of the surgical field.

Several cases of short-lived anesthesia in the maxillary central incisor region is usually noted.

Discussion

Multiple injection technique used for maxillary arch treatment is usually stressful hence the single block for treatment purpose has offered greater advantage and treatment acceptance. The benefit of palatal AMSA injection is that it reduces the number of injections, and also the amount of anesthetic solution compared to conventional buccal infiltration anesthesia that applies multiple injections to each tooth. In addition, more teeth can be anesthetized with a single injection, without numbness of lips and face (29). The majority of literature on the computer-controlled injection system (the Wand) has dealt with the pain of injection with the computer-assisted injection system, compared to injection using a conventional syringe (26). In general, the results have been favourable for the computer-assisted injection system, with only 2 studies showing no difference (27) and 1 study showing higher pain ratings10. Another study using the VRS (verbal rating scale) compared computer-controlled and conventional local anesthesia delivery systems for performing scaling and root planing on patients with moderate periodontal disease; AMSA injections with the Wand were considered less painful than the conventional syringe (28). Computer-controlled anesthesia using the Wand appears advantageous for restorative procedures because more teeth are anesthetized with one palatal injection, and without numbness of lips and face, in contrast to multiple conventional buccal anesthetic injections for each tooth. The AMSA injection is a novel anesthetic technique that may prove useful for certain maxillary periodontal surgeries (30).

Conclusion

The importance of this review was to bring about awareness among the general clinician who have to use multiple injection for any treatment to be performed in the maxillary arch. The non compliance of the treatment on the maxillary arch is usually due to these factors, hence introducing this technique can help patient compliance as well ease for the clinician also the duration of treatment is reduced.

References

1.
Malamed SF. Handbook of Local Anesthesia, 5th ed. St. Louis: Mosby; 2004:213-216.
2.
Gomolka KA. The AMSA block: Local anesthesia without collateral numbness. CDS Rev 2000;93:34.
3.
Friedman MJ, Hochman MN. Using AMSA and P-ASA nerve blocks for esthetic restorative dentistry. Gen Dent 2001;49:506-511.
4.
Malamed SF. Handbook of local anesthesia. 4th ed. St. Louis: Mosby; 1997. p. 149, 150, 160.
5.
Friedman M, Hochman M. A 21st century computerized injection system for local pain control. Compendium 1997;18:995-1003.
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Friedman M, Hochman M. The AMSA injection: a new concept for local anesthesia of maxillary teeth using a computer-controlled injection system. Quintessence Inter 1998;29:297-303.
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Blanton PC, Roda RS, The anatomy of local anesthesia. J Cal Dent Assoc 23(4):55-69, 1995.
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Donaldson D, James-Perdok L, et al, A comparison of Ultracaine, DS (articaine Hcl) and Citanest, Forte (prilocaine Hcl) in maxillary infiltration and mandibular nerve block. J Can Dent Assoc 1:38-42, 1987.
9.
Gibson RS, Allen K, et al, The Wand vs. traditional injection: a comparison of pain related behaviors. Pediatric Dent 22(6):458-62, 2000.
10.
Saloum FS, Baumgartner JC, et al, A clinical comparison of pain perception to the Wand and a traditional syringe. Oral Surg Oral Med Oral Pathol 89(6):691-5, 2000.
11.
Goodell GG, Gallagher FJ, Nicoll BK, Comparison of a controlled injection pressure system with a conventional technique. Oral Surg Oral Med Oral Pathol 90(1):88-94, 2000.
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Carter RB, Keen EN, The intramandibular course of the inferior alveolar nerve. J Anat 108:433-40, 1971.
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Rood JP, The nerve supply of the mandibular incisor region. Br Dent J 143:227-30, 1977.
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Frommer J, Mele FA, Monroe CW, The possible role of the mylohyoid nerve in mandibular posterior tooth innervation. J Am Dent Assoc 85(1):113-7, 1972.
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Madeira MC, Percinoto C, Silva MGM, Clinical significance of supplementary innervation of the lower incisor teeth: a dissection study of the mylohyoid nerve. O Surg O Med O Pathol 46:608-14, 1978.
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Sutton RN, The practical significance of mandibular accessory foramina. Aust Dent J 19:167-73, 1974.
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Haveman CW, Tebo HG, Posterior accessory foramina of the human mandible. J Prosthet Dent 35:462-8, 1978.
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Wilson S, Johns P, Fuller PM, The inferior alveolar and mylohyoid nerves: an anatomic study and relationship to local anesthesia of the anterior mandibular teeth. J Am Dent Assoc 108:350-2, 1984.
19.
Chapnick L, Nerve supply to the mandibular dentition: a review. J Can Dent Assoc 46:446-8, 1980.
20.
Holtzclaw D, Toscano N. Alternative anesthetic technique for maxillary periodontal surgery. J Periodontol 2008;79:1769-1772.
21.
Lee S, Reader A, Nusstein J, Beck M, Weaver J. Anesthetic efficacy of the anterior middle superior alveolar (AMSA) injection. Anesth Prog 2004;51:80-89.
22.
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