[Features of medical care provision in the profile «Maxillofacial surgery» in the Southern Federal District of the Russian Federation]

OBJECTIVE

To study the actual state of the organization of medical care for patients with the profile of «maxillofacial surgery» in the Southern Federal District of the Russian Federation in order to develop proposals for its optimization within the framework of a three-level system of medical care.

MATERIAL AND METHODS

We analyzed accounting and reporting materials characterizing the organization of medical care in the field of «Oral and maxillofacial surgery» to the population in the Southern Federal District of the Russian Federation.

RESULTS

The population of the Southern Federal District of the Russian Federation is currently provided with accessible round-the-clock medical care in the field of maxillofacial surgery. The forces and means at the disposal of the district government allow this to be implemented. However, the article describes a number of obstacles to the provision of high-quality medical care in the field of maxillofacial surgery and suggests ways to eliminate them.

CONCLUSION

Preparation of an Order defining the functioning of a three-level system of medical care for adults and children with maxillofacial pathology in the Southern Federal District of the Russian Federation, as well as more effective use of telemedicine consultations will significantly improve the availability and quality of medical care.

[Advantages and disadvantages of bone graft materials activated by BMP-2 and constructs carrying its gene]

In the review gene constructs and proteins used to impart osteoinductive properties to bone graft materials are compared. On the basis of clinical and experimental data the experience and prospects of their application in maxillofacial surgery and dentistry are described. Information about complications associated with the use of bone morphogenetic protein-2 (BMP-2) and vectors carrying its gene is provided.

[Models of bone defects in rabbits used to evaluate the bone graft materials efficacy]

The review deals with the main types of experimental models of bone defects of the skull in rabbits. The information about the types of critical defects, methods of their modeling and the possibilities of application of the described models in the studies of bone graft materials in dentistry and maxillofacial surgery is systematized.

[Study of properties of three-dimensional matrices manufactured by antisolvent 3D printing for reconstruction of extensive bone defects in dentistry and maxillofacial surgery]

OBJECTIVE

The aim of the study to study of physical, mechanical and biocompatible properties of the matrices manufactured by antisolvent 3D printing from the solutions of polylactide-co-glycolide in tetraglycol.

MATERIAL AND METHODS

Three-dimensional scaffolds were made from a solution of polylactide-co-glycolide mixed with tetraglycol using antisolvent 3D printing. The elastic properties and the structure of the obtained matrices were studied. MTT-test and staining with PKH-26, Calcein-AM, DAPI with subsequent fluorescence microscopy were used to study biological properties.

RESULTS

The three-dimensional scaffolds had good mechanical properties. Young's modulus value was 18±2 MPa, tensile strength was 0.43±0.05 MPa. The relative survival rate of cells after the first day was 99.58±2.28%, on the 14th day - 98.14±2.22%. The structure of the scaffold promoted cell adhesion and spreading on its surface.

CONCLUSION

The polylactide-co-glycolide matrices produced by antisolvent printing have high porosity, biocompatibility and good mechanical properties. It is allowed to use them in the future as a basis for personalized constructions for the replacement of extensive bone defects of the maxillofacial region.

[Development of osteoplastic gene-activated 3D matrices based on adenoviral vectors]

Gene therapy is one of the most promising approaches in regenerative medicine for the restoration of extensive bone defects in dentistry and maxillofacial surgery. Matrices obtained using three-dimensional printing from bioresorbable polymers, impregnated with adenoviral constructs with genes for osteoinductive factors, can ensure safe and effective formation of bone tissue.

OBJECTIVE

To study the properties of three-dimensional matrices based on polylactic-co-glycolic acid and adenoviral constructs with the GFP gene in vitro.

MATERIALS AND METHODS

The matrices were obtained by antisolvent three-dimensional printing. Transduction efficiency was assessed by fluorescence microscopy and flow cytometry. The cytocompatibility of the matrices was assessed by the MTT test and by staining cells with fluorescent dyes.

RESULTS

Matrices based on polylactic-co-glycolic acid have high cytocompatibility on adipose tissue-derived mesenchymal stem cells. Impregnation of adenoviral vectors with the green fluorescent protein gene in 3D matrices ensures the release of viral particles within a week, maintaining their high transducing ability.

CONCLUSION

The developed method for obtaining gene-activated matrices can serve as the basis for the creation of effective osteoplastic materials for bone regeneration.

[Long-term results of dental implantation in military personnel]

BACKGROUND

Currently, the use of the dental implantation method for the medical service of the Armed Forces of the Russian Federation is quite new. The method of dental implantation makes it possible to eliminate defects in the dentition of military personnel and other contingents eligible for medical care in military medical institutions of the Ministry of Defense of Russia.

OBJECTIVE

The aim of the study is to substantiate the medical effectiveness of the use of dental implantation in military healthcare.

MATERIAL AND METHODS

The study was conducted on the basis of the Department of Maxillofacial Surgery and Surgical Dentistry of the Military Medical Academy named after S.M. Kirov. The study is based on the analysis of long-term results of dental implantation according to medical histories and outpatient records. The study was conducted in 3 stages: stage 1 - study of the medical histories of patients who underwent dental implantation; stage 2 - examination of patients with dental implants and analysis of long-term results; stage 3 - a patient questionnaire was conducted to determine the effectiveness of dental implantation.

RESULTS

The structure of complications during dental implantation was revealed. Clinical examples of long-term results of prosthetics using dental implants are presented. It has been established that due to the peculiarity of military service and the remoteness of the locations of military units from the military medical organization, it is not always possible to conduct regular medical examinations and examinations of patients. To identify early symptoms of peri-implantitis, which is more often asymptomatic, preventive examinations of military personnel should be carried out 1-2 times a year.

CONCLUSION

To increase the service life of an orthopedic structure with installed dental implants, regular preventive examinations of patients to identify pathological processes are important. In favor of implantation, there is a choice for some categories of military personnel. This is especially important for flight and naval personnel, since dentures installed on dental implants are the only way to preserve their professional suitability in the military accounting specialty. The presence of teeth and the absence of removable dentures is an important requirement when performing combat missions.

[Analysis of compensation payments for moral damage in cases related to poorly provided dental care (2013-2022)]

THE AIM OF THE STUDY

Was an analysis of compensation payments for moral damage in cases related to poorly provided dental care in 2013-2022.

MATERIALS AND METHODS

The study of judicial practice for the period 2013-2022 was conducted on 1731 cases related to poor-quality medical care in dentistry and maxillofacial surgery. The analysis of statistical data on patients' claims for compensation for moral damage caused during the provision of dental care was carried out.

RESULTS

The most important and characteristic trends for the specialty were identified. In dental cases, claims for compensation for moral damage are contained in 97% of cases. In 56% of cases, on average, this requirement is satisfied by the courts. Over 10 years, the growth rate in the number of cases where these patient requirements were met was 36%. Data analysis shows an annual increase in the amount of compensation for moral damage requested and determined by the courts. During the study period, the growth rate of the number of cases with claims for compensation for moral suffering exceeding 100.000 rubles was 49%. The growth rate of court decisions and rulings on satisfaction of claims for compensation for moral damage in amounts exceeding 100.000 rubles was 44% from 2013 to 2022.

CONCLUSION

An important role in regulating the relationship between medical organizations and patients is played by the contract and the patient's voluntary informed consent to medical intervention.

[Comparative characteristics of the incidence of facial boils in military personnel and civilians]

THE AIM OF THE STUDY

To study the frequency and structure of the incidence of facial furuncle in military personnel of St. Petersburg and Leningrad region and civilians. To conduct a comparative analysis of the nature of the course, duration and outcome of the disease in military personnel and civilians (according to case histories).

MATERIAL AND METHODS

From 5744 case histories of patients with purulent-inflammatory processes of the maxillofacial region treated at the clinic of the Department of ChLH and Surgical Dentistry of the Kirov Medical University and St. Petersburg State Medical Institution «City Hospital No. 15» from 2017 to 2019, 201 case histories of patients with facial furuncle were isolated and analyzed.

RESULTS

According to the results of a study conducted from 2017 to 2019 in the clinic of the Department of CHLH and surgical Dentistry, a facial furuncle was detected in 65 cases. In the general structure of purulent-inflammatory diseases of the maxillofacial region, it was 3.1%. In the department of ChLH GB No. 15, 136 people were treated, which amounted to 3.7%. A lower percentage of the disease in military personnel is associated with early detection and timely initiation of treatment of purulent-inflammatory diseases of the skin. Weekly inspections of military personnel in military units, allow to avoid the development of complicated forms of their course. 95.0% of military personnel (47.0% of them contractors) and 51.0% of civilians were in the age group from 17 to 21 years. The main cause of the disease - hypothermia - in military personnel was 32.1%, in civilians - 20.9%. More often, the furuncle disease occurred in the spring: in military personnel in 44.6%, in civilians in 30.7% of cases. Localization of a boil in the buccal region occurred in military personnel in 15.4% of cases, and in civilians - in 20.8% of cases.

CONCLUSION

To prevent the disease of facial frunculus in military personnel, it is necessary to improve methods of prevention, diagnosis and treatment of patients, to provide consultations of related specialists: dermatovenerologist, endocrinologist, immunologist. In addition, it is necessary to observe the rules of personal hygiene with the use of individual skin care products (according to the type of facial skin), hardening of the body and vitamin therapy.

[Internal control of the quality and safety of medical activities in the field of information interaction between patient and medical organization]

The scope of information interaction between patients, medical organizations and regulatory authorities is regulated by a large number of legislative and regulatory documents, a number of which are discussed in this article. The quality of information interaction in the Russian Federation is assessed within the framework of internal quality control and safety of medical activities. At the same time, the analysis of court cases related to poor-quality dental care over 6 years allowed the authors to identify a large proportion of patient complaints about the quality of information interaction between patients and medical organizations. Questions of incorrect information of patients, incorrect storage and disclosure of information related to medical confidentiality were contained in 84% of court cases, their share was 12.15% of all claims of patients to the courts. The article analyzes the areas of internal quality control and safety of medical activities and discusses the need to develop special criteria for assessing the quality of the information environment of a medical organization.

[Applying the new conicotomy kit is the key to solve the problem of asphyxia at the prehospital stage]

OBJECTIVE

The purpose of this study is to analyze the incidence of asphyxia, therapeutic measures, the outcomes of treatment of the wounded with impaired secure airway and to assess the effectiveness of the prototype: «one-time set to eliminate asphyxia (conicotomy)» UK-02 (state defense order LLC «NOVOPLAST-M»).

MATERIAL AND METHODS

The basis of the analysis was the material of 2047 case histories-clinical test data on armed conflicts of Military Field Surgery Department of the Military Medical Academy named after S. M. Kirov. Development and evaluation of the effectiveness of the prototype set of UK-02 to eliminate asphyxia in the course of experimental studies was carried out on 6 biological objects (pigs).

RESULTS

The incidence of asphyxia is 1.5% according to national data and 8-13% according to the results of studies by foreign authors.

CONCLUSION

Complete and service equipment-a one-time set of UK-02 (to eliminate asphyxia (conicotomy) will reduce prehospital mortality and significantly improve the outcomes of treatment of the wounded with severe damage to organs and tissues of the maxillofacial region, ENT organs and pathological processes accompanied by impaired secure airway.

[Development of criteria for creating an electronic medical record of a dental patient]

The implementation of the unified state information system project in the health sector involves the creation of a single digital space in health care with the accession of medical organizations of all forms of ownership until 2024. Digitalization in dentistry will undoubtedly provide the doctor with additional resources and opportunities, but only if the correct implementation of digital technologies and techniques. Creating an electronic map of a dental patient is one of the most urgent and complex tasks since it involves the formation of completely new principles of the dentist's work. The study allowed creating criteria for establishing new e-cards for dental patients basing on assessment of problems associated with conventional paper medical records and taking into account expert assessments of medical documentation in judicial-medical examinations, examinations of quality of medical services and internal control of the quality and safety of medical activity.

[Complications during guided bone regeneration using a membrane based on titanium thread «Titanium silk»]

BACKGROUND

The titanium based membrane «Titanium silk» is widely used in guided bone regeneration (GBR) in the oral cavity, but the literature does not mention possible complications and methods of dealing with them.

OBJECTIVE

Improving the treatment of patients in cases of complications during GBR using a membrane based on titanium thread «Titanium silk».

MATERIALS AND METHODS

25 patients who applied to the Federal State Institution Central Research Institute of Dental and Maxillofacial Surgery, Ministry of Health of the Russian Federation underwent an operation of guided bone regeneration in order to create optimal conditions for dental implantation. In the postoperative period, dynamic monitoring of the condition of patients was carried out, where the healing of soft tissues was assessed and, if possible early or late complications were identified, timely measures were taken to combat them.

RESULTS

Of the 25 patients in the early postoperative period, in 2 cases, complications were identified, associated with exposure of the membrane, and in one case 4 months after osteoplastic surgery. However, adequate postoperative administration of these conditions allowed us to achieve a positive outcome of the treatment. Only in one case, addition GBR was required.

CONCLUSIONS

Most of the complications presented in this study during GBR had a multifactorial causes, depending on local and general factors of the patient. Early identification of complications and adequate postoperative management can lead to a positive final outcome of treatment.

[Orthopedic treatment of maxillary defects with the use of the residual resection prosthesis with pneumatic obturator]

BACKGROUND

Due to the growth of oncological diseases of the maxillofacial region, there is an increasing need to improve methods of orthopedic treatment of post-resection defects of the upper jaw with modern designs of replacement prostheses.

OBJECTIVE

Improving the quality of orthopedic treatment by creating an improved upper jaw resection prosthesis and justifying its use.

MATERIAL AND METHODS

We studied the effectiveness of orthopedic treatment of post-resection defects of the upper jaw using the proposed replacement prosthesis with a pneumatic obturator. A special questionnaire was used to analyze the level of adaptation and maladaptation of patients.

RESULTS

There was a significant decrease in complaints and adaptation time in the group of patients with a replacement prosthesis with a pneumatic obturator.

CONCLUSION

The use of the proposed resection removable prosthesis helps to reduce the period of adaptation to the prosthesis, which indicates that it can be widely used in clinical practice.

Development prospects of curable osteoplastic materials in dentistry and maxillofacial surgery

The article presents classification of the thermosetting materials for bone augmentation. The physical, mechanical, biological, and clinical properties of such materials are reviewed. There are two main types of curable osteoplastic materials: bone cements and hydrogels. Compared to hydrogels, bone cements have high strength features, but their biological properties are not ideal and must be improved. Hydrogels are biocompatible and closely mimic the extracellular matrix. They can be used as cytocompatible scaffolds for tissue engineering, as can protein- and nucleic acid-activated structures. Hydrogels may be impregnated with osteoinductors such as proteins and genetic vectors without conformational changes. However, the mechanical properties of hydrogels limit their use for load-bearing bone defects. Thus, improving the strength properties of hydrogels is one of the possible strategies to achieve the basis for an ideal osteoplastic material.

[Regulatory framework of the new system of wage payment in research institutions]

Changes in the legislation, the development of the regulatory and legal framework governing relations in the sphere of wage payment for health care workers has caused the transition of medical organizations to the new system of salaries payments (NSWP). This system has given executives and economists significant freedom when determining the size of payments to the employee per hour worked, including stimulating and compensation payments, bonuses and other regular pension benefits. However, given situation has also resulted in the need for studies intended on the formulation of the criteria's for medical workers of different specialties actions evaluation and the quality of medical services that they have provided, as well as on the efficiency of the health care organizations in general.

Morphological and Molecular-Biological Features of Inflammatory and Regeneratory Processes in Peridont Tissues with Periimplantitis and Periodontitis

A morphological and immunohistochemical study of periodontal tissues was performed in patients with chronic generalized periodontitis who underwent dental implantation. We studied 44 biopsy specimens from 21 patients (13 women and 8 men) aged 35-60 years with a diagnosis of periimplantation mucositis (7 patients), periimplantitis (8 patients), and severe chronic generalized periodontitis (6 patients). It was established that periimplantitis differs from periimplantation mucositis by a more pronounced inflammatory reaction with a clear predominance of plasma cells in the infiltrate, which captures the fibrous capsule around the implant, destroys it and further spreads to the bone tissue. Based on the immunohistochemical differences in SMA, VEGF, and Ki-67, it is concluded that periimplantation mucositis and periimplantitis are successive stages of progression of the same process. When comparing chronic generalized periodontitis and periimplantitis, the latter shows much more pronounced inflammatory and destructive processes in the area of the implant, due to the addition of immune inflammation, impaired regeneration processes, and destruction of bone tissue.

[Chitosan hydrogels biocompatibility improvement with the perspective of use as a base for osteoplastic materials in dentistry]

Using chitosan as the basis for osteoplastic material, we were dealt with its low biocompatibility. The critical assessment of it is poorly presented in the literature and does not have systematic approaches to solving. The aim of the study was to determine the effect of factors affecting chitosan charge and its free amino groups number on the biocompatibility of hydrogels. Biocompatibility of chitosan compositions were studied in male Wistar rats (n=90). The subcutaneous implantation of chitosan discs and hydrogel caused abundant leukocyte infiltration. The addition of β-glycerophosphate followed by dialysis slightly reduced the inflammatory response. Treatment with a solution of alkali NaOH and NaHCO3 buffer, on the contrary, intensified the inflammatory response. It is confirmed the effect of charged amino groups of chitosan on leukocyte taxis A decrease in the deacetylation degree (DD) of chitosan to 39.0% led to a statistically significant decrease in leukocyte infiltration. Saturation of chitosan hydrogels with PLA granules reduced by 16% the level of leukocyte infiltration, which was supposedly associated with a decrease in the volume of the hydrogel and an increase in the area of its interaction with blood plasma proteins, which reduce the positive charge of chitosan. The most significant reduction in leukocyte infiltration was achieved with a combination of deacetylated to 39.0% chitosan hydrogel with the addition of 16% by weight highly porous PLA granules.

[Biocompatibility and osteoinductive properties of collagen and fibronectin hydrogel impregnated with rhBMP-2]

The study aimed to demonstrate the biocompatibility and osteoinductive properties of a hydrogel based on highly purified collagen and fibronectin impregnated with rhBMP-2. In vitro and in vivo experiments have shown that the minimum effective dosage of rhBMP-2 is 10 μg/ml. The cytocompatibility of the collagen-fibronectin gel was determined using MTT test and staining with PKH-26. There was no inflammation reaction when the material was subcutaneously implanted in rats (n=30) in vivo. The collagen-fibronectin hydrogel containing 10 μg/ml rhBMP-2 showed high osteogenic properties. By the end of 28 days 8±4% of its volume was replaced by newly formed bone tissue in case of subcutaneous implantation, 17±10% in intramuscular implantation and 26±11% in intraosseous implantation in the calvarial critical-size. The optimal combination of biocompatible and osteogenic properties of collagen-fibronectin hydrogel impregnated with BMP-2 allows us to consider it as a promising basis for creating the new generation of osteoplastic materials for dentistry.

[The role of clinical recommendations in ensuring the quality of care in dental implantation]

The study presents the analysis of the materials of court cases related to the shortcomings in the provision of dental care for dental implantation and the conclusions of forensic examinations of the quality of implantological care. The analysis identified the possibility of using clinical guidelines as a normative document containing criteria for assessing the quality of dental care. The analysis of unfavorable outcomes of treatment that led to legal proceedings, claims of patients and issues submitted for examination allowed to determine the quantitative composition and structure of the main violations in the provision of dental care using methods of dental implantation. The study revealed the lack of certain required assessment criteria and the limitations of the composition of patient models contained in the existing clinical recommendations that interfere with the assessment of the quality of dental care.

Immunohistochemical and Morphological Study of Periodontal Tissues in Predicting the Results of Dental Implantation in Patients with Chronic Periodontitis

Morphological and immunohistochemical examination was made on 24 gum biopsies obtained from 35- to 60-year-old patients with diagnosis of partial secondary adentia, chronic generalized moderate to severe periodontitis (19 patients), as well as on the biopsy samples from five patients without pathological periodontal changes who underwent dental implantation. Serial paraffin sections were treated with antibodies against Ki-67, VEGF, and SMA. In patients with severe chronic periodontitis, a high proliferative activity of epithelium indicative of hyperplastic changes was observed, as well as a reduced number of the SMA-positive cells and actual absence of the SMA-positive cell couplings associated with the "growth zones" in tissues, which testifies indirectly to a lower tissue regenerative capacity. Hence, before dental implantation, additional anti-inflammatory and pro-regenerative treatment is required.

[Risk-based approach to the organization of dental implantological care based on judicial practice]

The article proposes methods of modeling the activities of medical organizations to improve the quality of dental care using dental implants based on risk-based approach. The method allows optimizing the system of internal quality control and safety of medical activities and to form a risk management plan. The main types of risks in the work of dentists-surgeons and orthopedic dentists were systematized and generalized by means of the analysis of judicial practice in dentistry for 2013-2017. The results may be used in the development of preventive measures and building a system of quality control for dental care using dental implants.

[Safety and efficacy of BMP-2 and BMP-7 use in dentistry]

The article deals with bone morphogenetic proteins BMP-2 and BMP-7 with high osteoinductive potential. The materials containing these proteins are considered. Their safety and efficacy for regeneration of maxillofacial bone defects are evaluated. The prospects of bone tissue regeneration technologies development based on the use of bone morphogenetic proteins are described.

[Organizational and legal aspects of implant dentistry according to the analysis of judicial practice]

The aim of the study was the analysis of complex forensic examinations and decisions of civil courts in cases related to poor-quality provision of implant care in 2013-2016. It determines specific features and algorithms for optimization of legislative protection system for dental surgeons and prosthodontist by provision of implant-related dental care.

[Factors affecting osteointegration and the use of early functional load to reduce the duration of treatment in dental implantation]

The article presents literature data on the impact of the surface and shape of dental implants and early functional load with aesthetic and functional rehabilitation on osteointegration and stability of implants at various implantation terms.

[The prospects of collagen as a basis for curable and activated osteoplastic materials]

In the review, the structure and biological properties of collagen, variants of its production from natural sources and purification are considered. Methods for modifying the physico-mechanical properties of collagen to create a curable, highly purified collagen hydrogel are described. The advantages of a cured highly purified collagen hydrogel as a basis for osteoplastic material and a means of delivery of growth factors are indicated. The registered osteoplastic materials based on the curable highly purified collagen hydrogel are described, and their comparative analysis is carried out. On the basis of the obtained data, a conclusion was made about the prospects of using collagen as a basis for curable and activated osteoplastic materials.

[Increasing the effectiveness of mandibular molars root resection surgery using retrograde endodontic revision]

The purpose of the present study was to increase the effectiveness of mandibular molars apical root resection surgery. The study included 21 patients with diagnosis 'persistent apical periodontitis', 'root cyst', in 11 cases surgery was performed with less traumatic access with piezoelectric surgery system for separation of cortical bone block and subsequent reposition after resection and retrograde root filling. The planning and procedure was described by 2 clinical cases. Bone block reposition surgical procedure showed clinical effectiveness and was considered as a most acceptable technique of root resection.

[Regeneration of dental pulp tissue using pulpal autologous mesenchymal stem cells and platelet-rich plasma]

Regeneration of pulp and dentin could be important in operative dentistry as a method to save teeth. Currently cell population from dental pulp of deciduous and permanent teeth of humans and laboratory animals are isolated and characterized. The paper presents a study on pulp regeneration using autologous mesenchymal stromal cells from pulp of molars in combination with fibrin clot, transplanted in pulp chamber of miniature pigs after pulp removal. The results proved that transplantation of autologous multipotent stromal cells of dental pulp in combination with autologous platelet-rich plasma in pulp chamber of miniature pigs after pulp removal leads to pulp restoration and reparative dentinogenesis with dentinal bridge formation on the 30th day. However, the completion of regeneration also results in a decrease in the pulp chamber volume due to the neodentin bedding. Tissue regeneration of dental pulp by direct pulp capping in the absence of inflammatory processes is a promising direction of the use of cellular technologies.

[In vitro evaluation of two methods for fractured screw retrieval from dental implants]

The aim of the study was to compare estimated efficiency of fractured dental implant screw removal methods. Twenty screws in implant internal connections were fractured in animal model to test fragment retrieval comparing two methods: using ultrasonic tools (group 1, 10 implants) and special reverse force kit (group 2, 10 implants). Removing screws with ultra-sonic tools proved to be slightly more effective, than using specialized kit. Mean procedure time in group 1 was 4 min more than in group 2. The possibility of screw retrieval correlates with fracture level, as deeper fractured screws were the easiest ones to remove.

[Legislative regulatory framework for medical care quality and safety control]

The paper presents the analysis of legislative and regulatory framework for the control of the quality and safety of medical activities. Legislative and regulatory framework requires mandatory internal control of the quality and safety of medical activities and dictates its structure. In the development of the internal control of the quality and safety of medical activities there is, however, a need to consider medical and social, legal, organizational, ethical and economic issues.

[Human resources provision for maxillofacial surgery facilities]

The aim of the study was to analyze the key trends of medical staff provision for maxillofacial surgery facilities. It is established that the provision of the population with maxillofacial surgeons staff has slightly decreased from 0.08 (year 2011) to 0.06 (year 2015). The amount of staff positions at this period has increased by 17.22%, the intensity of growth of employed positions has grown by 15.74%, which makes the understaffing rate equal to approximately 8-10%. The coefficient of part-time workers has also varied slightly from 1.4 in 2011 to 1.26 in 2015. Over 93% of maxillofacial surgeons work in hospitals. The qualification category was awarded to over 46.0% of specialists in this field, 97.6% of maxillofacial surgeons have a specialist certificate. The results indicate the need for a new project of personnel policy strategy for further training and professional growth of maxillofacial surgeons.

[The prospects of hydrogels usage as a basis for curable osteoplastic materials]

The article deals with the main types of the polymers used in hydrogel preparation. Their biological, physical and chemical properties was compared. Ways of polymers hardening and prospects of medical application were considered. The prospect of use of chitosan hydrogels activated by osteoinductors as a material for bone augmentation were concluded.

[Legal aspects of providing medical care to patients with intolerance of dental materials]

The paper presents an analysis of legal documents describing the legal side of dental care to patients with intolerance of dental materials (IDM). The features of dental treatment from the point of view of the risk of IDM are described with the examples of real court cases in precedent as well as the conditions for the onset of strict liability and exemption from liability in relation to the practice of treatment of patients with IDM.

[Modern approaches to dental implants placement in deficient alveolar bone]

The paper presents statistical data on implant placement procedures in Central Research Institute of Dentistry and Maxillofacial Surgery (Moscow, Russia) in 2010-2015. In 64% of cases inadequate bone volume was attributed to alveolar bone atrophy. Bone deficiency was equally often in upper and lower jaws (in 49.3 and 50.7%, correspondently) but varied in forms with complex configurations to be more specific for maxilla. The study also includes a series of clinical cases illustrating implant placement procedures in anatomically unfavorable settings.

[Improvement of training quality in continuous medial education of dentists and maxillofacial surgeons]

The new concept of continuous medical education is based on individual learning paths of each specialist in conjunction with the use of modern educational technologies, including IT. The aim of this study was to undertake a review of modern methods of health care professionals training in the framework of continuous medical education profile introduced by the Ministry of Health. The paper presents the best IT practices of Central Research Institute of Dentistry and Maxillofacial Surgery in the training of dentists and maxillofacial surgeons aimed for the modernization of medical education.

[Elaboration of health care quality criteria in maxillofacial surgery]

Criteria of quality of care in oral and maxillofacial surgery should reflect not only the quality of the repair functions of chewing, swallowing, breathing, speech, and should take into account the psycho-emotional condition of the patient; satisfaction of its appearance, quality cosmetic fill configuration of the face, tooth defects, smiles; adaptation to implants and dentures; their quality, the conditions and possibilities of their use. The application of the provisions of the international classification of functioning, disability and health in oral and maxillofacial surgery, is a condition that will allow to unify the approaches to the development of quality criteria of this type of medical care.

[The atraumatic restorative treatment approach in pediatric dental care: a comparative clinical study]

The aim of this study was to assess and compare the discomfort levels during Atraumatic Restorative Treatment and Minimal Cavity Preparation using rotary instruments and Air abrasion method. The results of the study suggest that ART induces less discomfort, therefore this method can be recommended for children who have a fear of dental procedures as well as for children with intellectual disabilities.

[Impact of various second-stage implant surgery methods on adjacent gingival tissues microcirculation]

The paper presents the rezults of laser doppler flowmetry (LDF) studies of microcirculation in gingival tissues around dental implants disclosed by different methods. Microhemodynamics in gingival tissues when using a scalpel recovered after 14 days, carbon dioxide laser -- 7 days and erbium laser -- 3 days, which may be important in the choice of the operation tactics.

[Comparative study bone tissue temperature changes by using conventional and piezosurgical methods in dental implantology]

The laboratory study compared thermal bone lesion by the formation of dental implant bed using traditional and piezosurgical method with varying degrees of irrigation. The study was carried out on cadaveric mandible and porcine mandible with preserved soft tissues. Implant bed was formed by Implantmed dispenser (W&H, Austria) and AstraTech drills (Sweden) according to standard clinical protocol or by piezosurgical device Implant Center (Satelec Acteon Group, France) with Intra Lift II (Satelec Acteon Group, Франция) and №1 scalpel tips with D1 power under minimal and maximal irrigation. The results showed that the formation of the bone bed was safe when using both conventional and piezosurgical method under copious irrigation. The possibility of bone tissue thermal damage increases when using minimum irrigation or no irrigation.

[Surgical treatment of mandible fractures in heavy drinkers]

The number of alcohol abusing patients with maxillofacial trauma hospitalised in reanimation department or specialized departments is constantly growing and was estimated as 36% in the current study. Patients with acute or chronic alcohol intoxication and fractures of the lower jaw have problems with fracture fixation. Traditional surgical fixation methods are traumatic and not always effective. The study evaluates the efficiency of new surgical methods of mandible fractures fixation in patients with chronic or acute alcohol intoxication.

[The results of resonance frequency analysis by dental implantation after bone augmentation for alveolar bone atrophy]

The report concerns dental implantation effectiveness in case of jawbone atrophy. Thirty patients were included in the study to reveal resonance frequency analysis rates of intraosseous dental implants by dental implant placement with bone augmentation using the veneer technique of cortico-cancellous blocks and guided bone regeneration (GBR) with biodegradable membranes and pins having poly (dl- lactic acid) base.

[Wound bacterial flora by different methods of second-stage implant surgery]

Microbiological studies of wound around dental implants disclosed by different methods. Significant differences between the methods have not been identified that may be important in the choice of tactics of the operation.

[Reaction of bone tissue elements on synthetic bioresorbable materials based on lactic and glycolic acids]

The aim of the study was to evaluate the adverse effects of synthetic polymeric bioresorbable materials based on lactic and glycolic acids on the bone tissue. The study was carried-out on 40 Wister-line rats. Four types of bioresorbable polymeric materials were implanted: PolyLactide Glycolide Acid (PLGA), Poly-L-Lactide Acid (PLLA); Poly-96L/4D-Lactide Acid (96/4 PLDLA); Poly-70L/30D-Lactide Acid (70/30 PLDLA). The results showed connective tissue formation (fibrointegration) bordering bone adjacent to implanted materials. This proved the materials to cause pathogenic influence on the bone which mechanisms are described in the article.

[Clinical and radiological study on tissue regeneration after alveolar bone augmentation with various osteoplastic materials and membranes]

The aim of the study was to compare the efficiency of alveolar bone augmentation using a variety of osteoplastic materials and collagen membrane and healing under a clot. The study included patients undergoing the extraction of symmetric teeth. After extraction one of the sockets were filled with osteoplastic materials while symmetrically located socket with no bone grafting served as a control. In group 1 augmentation was performed using Bio-Oss Collagen Bio-Gide membrane, in group 2 - Osteodent-M and Collost membranes, in group 3 - BIOPLAST-dent and BIOPLAST-dent-MK membranes. Clinical and radiological evaluation revealed positive impact of bioplastic materials on the bone tissue healing and recovery rates. The best results showed Bio-Oss Collagen with barrier bioresorbable membrane Bio-Gide allowing the creation of the most favorable conditions for delayed implantation.

[Advantages of multidisciplinary approach to diagnosis and treatment of mandible fractures in alcohol abusing patients]

The diagnosis of traumatic injuries in patients with chronic and severe alcoholic abuse is very complicated especially in cases with associated brain injuries. It is particularly difficult to provide anesthesia and resuscitation, complications arise when taking certain groups of drugs. The associated immune system disorders are risk factors for complications. The most reasonable approach to diagnosis and treatment of mandible fractures in such patients is a multidisciplinary approach involving expert team with maxillofacial surgeon playing a leading role.

[Ergonomics in oral surgery and dental implantology]

The study objective was to reveal incidence, location and intensity of musculoskeletal pain in 88 dentists working in various units of Central Research Institute of Dentistry and Maxillofacial Surgery, as well as to identify pain predisposing factors and preventive measures. High rate (95.9 ± 5.03%) of musculoskeletal pain was revealed, mostly located in cervical region. The pain occurred more often in younger dentists. High incidence of musculoskeletal pain proves the necessity for preventive measures including optical magnification devices.