CLINICAL TECHNIQUES
P-ASA
The Palatal Anterior Superior Alveolar (P-ASA)
The P-ASA is another modified injection for the anterior maxilla. It will allow the
operator to achieve bilateral anesthesia of the maxillary incisors and usually the
canines from a single needle penetration. In addition to pulpal anesthesia,
profound palatal anesthesia of the gingiva and mucoperiosteum as well as
moderate anesthesia of the facial gingiva associated with the teeth is achieved.
The recommended dosage is from 3/4 to 1 cartridge of anesthetic with the
expected duration of anesthesia of approximately 60 minutes. Of significant
benefit is that the lips, face and muscles of expression are not anesthetized with
the P-ASA. This results in greater patient comfort operatively and post
operatively. In addition, esthetic smile-line assessments are not hampered by
facial distortion associated with traditional mucobuccal fold injections in this
region.
The P-ASA is easily administered, requiring from 2 - 4 minutes to complete.
Anesthesia is achieved within approximately 2 minutes of injection. The patient
should be prepared for the extra time required to administer the P-ASA and
advised they will likely experience only a minor sensation during the injection.
They will appreciate the lack of numbness to the face and lips.
A 30 gauge extra-short needle is recommended. It is inserted adjacent to the
incisive papilla. If desired, topical anesthetic may be applied. The needle bevel is
initially oriented as parallel to the palatal tissue as possible. A sterile cotton tip
applicator is employed to apply pressure on the needle to “seal” the bevel to the
tissue for the “pre-puncture” phase of the insertion. (see pre-puncture section)
The foot control is depressed slightly to activate the slow flow rate for 8 - 10
beeps prior to slow needle insertion. The cotton tip will help catch any anesthetic
drips that occur before the bevel is completely within the tissue. The needle
movements are extremely slow and gentle during penetration while the slow flow
rate is maintained. After penetration into the papilla, insertion is continued until
significant blanching of the papilla is observed. The needle is then reoriented to
gain entrance into the nasopalatine canal and advanced very slowly no more
than 1 cm (approximately the depth of a 1/2”needle). Maintain contact on bony
wall of the canal and then aspirate. Deliver the required dosage of 3/4 to 1
cartridge. Significant blanching of the palate tissue and often the facial tissue will
Friedman MJ, Hochman MN. P-ASA Block Injection: A New Palatal Technique to Anesthetize Maxillary Anterior Teeth, Journal
of Esthetic Dentistry, 1999, Vol. 11, Number 2.
Dosage requirement for adequate anesthesia and duration may vary from one patient to another.
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