Middle Superior Alveolar Technique: Efficacy in the Premolar Maxillary Region

A randomized, single-blind clinical trial was conducted to compare the efficacy of the infraorbital technique with the middle superior alveolar (MSA) technique in achieving pulpal anesthesia of maxillary premolars.

Thirty voluntary subjects received 1.8 milliliters of 2% lidocaine with 1:80,000 epinephrine. The researchers assessed the degree of pulpal anesthesia with an electronic pulp tester, puncture pain, soft-tissue anesthesia and patient comfort at this anesthesia, and start time and duration of anesthetic effect. The data was analyzed using the Shapiro-Wilk, Mann-Whitney, and McNemar tests.

Deep pulpal anesthesia in the MSA technique was significantly higher when compared to the infraorbital technique in first and second premolars, the results being 95.2% and 100% respectively for the former technique and 66.7% and 42.9% respectively for the latter technique. The authors noted statistical significance in the perception of pain associated with the injection, with the infraorbital technique being the more painful technique (P = .003). The onset of the anesthetic effect was shorter after applying the MSA technique, and the duration of anesthetic effect was significantly higher with this technique. The incidence of subjective anesthesia of lips, skin, nasal wing, and gingiva was 100% for the infraorbital technique, with greater discomfort reported for the soft-tissue anesthesia in this technique.

The MSA technique proved more effective in achieving pulpal anesthesia of maxillary premolars in comparison to the infraorbital technique.