Efficacy of anterior and middle superior alveolar (AMSA) anesthesia using a new injection system: the Wand

Quintessence Int. Jul-Aug 2003;34(7):537-41.


Objective: This study examined the effect of anterior and middle superior alveolar (AMSA) field block of maxillary nerves using a new local anesthetic system--the Wand.

Method and materials: Twenty healthy volunteers aged 23 to 44 years were used in the study. Either side of the maxillary teeth was randomly selected for AMSA injection; the other side was left as a control. For each side, 1.8 mL of 2% lidocaine solution with 1/80,000 epinephrine was injected by the Wand on a point that bisects the maxillary first and second premolars and is midway between the crest of the free gingival margin and the midpalatine suture. Pain rating score (PRS) and visual analogue scale (VAS) were applied for measurement of puncture, insertion, and injection pain. Electric pulp stimulation was given to each maxillary tooth every 10 minutes for 1 hour after the injection in order to find out the specific tooth on which AMSA injection was effective.

Results: During needle insertion, 14 out of 20 subjects answered moderate pain and VAS showed 27.3 mm (mean). During injection, 11 of 20 revealed no pain and the mean of VAS was 14.5 mm. No one claimed severe pain by PRS. Electric pulp stimulation indicated that lateral incisors, canines, and first and second premolars were more anesthetized than central incisors and first molars.

Conclusion: AMSA injection using the Wand method seems to avoid severe injection pain and seems to be very effective for pulpal anesthesia at lateral incisors, canines, and premolars.

Publication types

  • Clinical Trial
  • Randomized Controlled Trial

MeSH terms

  • Adult
  • Anesthetics, Local / administration & dosage*
  • Bicuspid / innervation
  • Cuspid / innervation
  • Dental Pulp / innervation
  • Electric Stimulation
  • Humans
  • Incisor / innervation
  • Injections / adverse effects
  • Injections / instrumentation
  • Lidocaine / administration & dosage
  • Matched-Pair Analysis
  • Maxillary Nerve* / drug effects
  • Nerve Block / instrumentation
  • Nerve Block / methods*
  • Pain / prevention & control
  • Pain Measurement
  • Punctures / adverse effects
  • Time Factors


  • Anesthetics, Local
  • Lidocaine