[Stafne defect as a rare anomaly of the lower jaw growth]

Defects in mandible growth are of undoubted interest for practical healthcare. During the diagnosis, for a more accurate diagnosis and differential diagnosis, it is necessary to understand the criteria for the norm and pathology of diseases of the jaw bones. Often in the body of the mandible at the level of the lower molars, slightly below the maxillofacial line, defects are detected in the form of a depression of the cortical layer towards the unchanged buccal cortical plate. These defects, being the clinical norm, need to be differentiated with many tumor diseases of the maxillofacial region. The literature sources indicate that the cause of these defects is the pressure of the capsule of the submandibular salivary gland in the area of the fossa on the lower jaw. Modern additional diagnostic methods, for example, CBCT and MRI, make it possible to identify a Stafne defect.

[Classification of lower impacted third molars position and their interrelationship with mandibular canal]

Classification of lower Impacted third molars position and their interrelationship with mandibular canal have a great scientific, theoretical and practical importance. An attempt to systematize and classify all anatomical impacted third molars position has been made by many authors. Based on our scientific literature search, we found: 8 impacted third molars classifications, 7 third molars and mandibular canal interposition classifications, as well as 5 classifications of mandibular canal anatomical branching variants. Most classifications are proposed by the author to predict third molar eruption perspective, determine level of operation complexity and prevent mandibular canal damage. New clinical classification development of impacted third molars interrelationship with mandibular canal, which combined the radiological PR, CBCT criteria, neurovascular bundle trauma prognosis, and operative technic choice can be actual.

[Microanatomy features in third molars roots adjacent to mandibular canal]

THE PURPOSE

Of the study is to reduce the risk of postoperative neuropathy of the inferior alveolar nerve by improving diagnostic methods, assessment of individual topographic and anatomical features and extraction technique of impacted teeth adjacent to the mandibular canal.

MATERIALS AND METHODS

According to the CBCT examination, orthopantomography and macroscopic examination of removed third molars roots (n=140) the relative position of the mandibular canal and the roots of the third molars were studied.

RESULTS

Three variants of close mandibular canal and third molars position have been identified. In the lateral and apical nerve position, the root surface depressions were detected. With inter-radicular position fit, the mandibular canal and the nerve bundle form a «bed» in between impacted tooth roots.

CONCLUSION

The injury of neurovascular bundle prognosis during extraction with an interadicular mandibular position depends on roots anatomy and their convergence degree. If the interradicular distance is less than the diameter of the mandibular canal, nerve injury during tooth extraction is inevitable, in such cases coronectomy is indicated.

[Analysis of medical records as an element of quality control and safety of medical activities]

OBJECTIVE

Studying the issue of quality control and safety of medical activities.

MATERIAL AND METHODS

The analysis of domestic literature on the quality of filling out medical documentation has been carried out.

RESULTS

A dental patient's medical record (ICSD) is not only the most important legal document, but also a certain indicator of the level of professional competence of a dentist. To find out all sorts of reasons that led to professional errors and adverse consequences after the provision of dental care, a thorough study and general analysis of medical documentation is of great importance, the maintenance and correct execution of which is also necessary for solving a number of other, including legal issues. The most common drawbacks in the design of a dental patient's medical record have been identified, which indicates a decrease in the quality of medical care provided to patients.

CONCLUSION

At the moment, there are still unresolved issues related to complete completion of medical documentation. When analyzing the literature, we did not find a purposeful study of the medical history of a dental patient during surgical treatment, which requires further research.

[Surgical treatment tactics in patients with third molars located close to mandibular canal]

The tight fit of the roots of the third molars to the mandibular canal is the main predisposing factor of injury to the inferior alveolar nerve during tooth extraction surgery. Surgical treatment of 92 patients diagnosed with pericoronitis, retention of the third molar of the mandible, close fit of the roots of the third molar to the mandibular canal was performed. Four types of close fit of the roots of the third molars to the mandibular canal were revealed, according to CBCT, OPTG and clinical data. Most cases of paresthesia after the removal of the third molars are associated with an anatomical variation in the structure of the mandibular canal, in which the canal walls are partially formed by the cement of the tooth root. Two variants of postoperative management of the surgical wound are proposed, when an open section of the neurovascular bundle is detected at the bottom of the hole.

[Aspiration test as dental anesthesia safety criterion]

Intravascular anesthetic injection can lead to acute toxic reaction even the minimal dose of the drug was administered. The aspiration test is a generally accepted standard for local anesthesia in medicine, specially designed to reduce the risk of emergency conditions. Medical instruments should be adapted for aspiration test, the local anesthetic carpule should have a retention notch, and the dental syringe plunger need to have retention elements. The aspiration test protocol may vary. For legal protection of the doctor the aspiration test result should be described in the patient's medical record.

[Severe spine lesion following alkaptonuria. Case report]

Alkaptonuria is a rare autosomal recessive disease. In these patients, melanin-like compounds as the final products of impaired metabolism of homogentisic acid are deposited mainly in connective tissue, including cartilage tissue of intervertebral discs. Similar to other degenerative spine diseases, lumbar segment is often damaged. The authors report a 67-year-old patient with alkaptonuria. Compression of cauda equina by damaged cartilage masses of intervertebral discs and spine ligaments with deposits of ochronotic pigment is described. Previously diagnosed alkaptonuria in this patient was confirmed by surgical findings (black pigmentation) and histological data.

[Root dislocation into the mouth floor as a complication of lower impacted third molar extraction]

Root dislocation into soft tissues during lower jaw third molar extraction belongs to clinically rare complications. The thickness of the cortical plate on the third molar lingual side does not exceed 1.5 mm. Working with an elevator, or headpiece, it is possible to push the roots into the adjacent soft tissue. It is not possible to remove displaced tooth fragment through the socket, it requires additional surgical access from the lingual side. The authors described three clinical cases of root dislocation during third molar removing. Successful surgical treatment was done.

[Lower teeth anesthesia in patients with limited mouth opening]

Limited mouth opening is a common pathology in dental practice. Dental treatment of these group patients is hindered by low access to oral cavity, which complicates operative, prosthetic and surgical interventions. Local anesthesia is also difficult due to changes in anatomical landmarks, changes in bone structures and soft tissues ratio. M.M. Weisbrem and Gow-Gates technique in case with limited mouth opening 1-2 cm is ineffective. Mandibular convention block is more universal, as it is oriented to bone structures without binding to soft tissues. Variation of local anesthesia techniques at a various mouth opening degrees are offered.

[The effectiveness of tooth-preserving surgery in various forms of inflammatory and destructive lesions in mandibular molars area]

The aim of the study was to analyse the effectiveness of tooth-preserving surgery in various types of odontogenic destructive lesions in lower molars area treated in the outpatient surgical department of Central Research Institute of Dentistry and Maxillofacial Surgery from 2011 to 2017. The study defined th percentage of complications and positive outcomes depending on the type of distribution of inflammatory-destructive process.

[Dental care for patients at risk of adverse reaction to local anesthetics]

The study comprised 53 patients with side effect history to local anesthetics. The reasons for the occurrence of adverse reactions to local anesthetics was analyzed, and the frequency of their occurrence in dental practice was studied. It was found that in most patients (85%) with 'allergic reactions' to local anesthetics the diagnosis was unreasonable and incompetent. In most cases psychosomatic reactions were mistaken for an immediate allergic reaction. The prevalence of adverse reactions to local anesthetics was 1 case per 448 injections (1:448), true allergic reactions was documented in 0.1% cases.

[Needle fractures during mandibular block: prevention and emergency care algorithm]

Cases of dental needle fracture during mandibular block were studied in the last 10 years. Despite dental anesthesia development, the cases of needle fracture occur regularly in the world practice. Some of these complications has iatrogenic nature while others may be attributed to independent reasons like patients' sharp movement and needle manufacturing defect. In most of the cases the needle migrates to surrounding anatomical spaces making operative removing a challenging task. Subsequent surgical removing of a foreign body has severe consequences to patient in the form of a large operating injury, long-term disability and functional limitations. The article presents an algorithm for prevention and emergency care for a patient with dental needle fracture during mandibular block.

[Clinical and radiological features of inflammatory lesions in the lower molars area]

The study objective was to analyze clinical manifestations by various forms of inflammatory destructive lesions in lower molars area. The study included 54 patients aged 20 to 66 years with odontogenic alveolar bone defects in lower molars area. Typical clinical and radiological signs are described for each type of destructive lesions. Sinus tract located more coronal and 'areolar' bone resorption may indicate root perforation. Clinical and radiological features may help in choosing optimal surgical tactic.

[Technical features of intraligamental intraseptal anesthesia]

Based on personal clinical experience the authors provide clinical guidelines for periodontal anesthesia. The by-step protocol for intraligamentary and intraseptal anesthesia is presented. The basic mistakes in technique and possible complications are described. Recommendations for a local anesthetic choice and dosage for different groups of teeth are given.

[Modern wound dressings in oral surgery]

In this review the modern wound dressings used in surgical dentistry and maxillofacial surgery are studied. We describe the tupes of wound dressings and their properties. The results of clinical use in various surgical procedures in the oral cavity are presented.

[Topographic features of lingual nerve and its relationship with other anatomical structures in maxillolingual groove]

By surgical interventions in maxillolingual groove area one should consider anatomical variations and topography of vessels, glands ducts and lingual nerve to prevent their injury. At the Department of Operative Surgery and Topographic Anatomy of the First Moscow State Medical University named after I.M. Sechenov we carried out anatomical study on cadavers (men and women, n=30).The study revealed topographical features of the lingual nerve and its relationship to other anatomical structures in the maxillolingual groove. It was found out that at the level of the second molar (96%) lingual nerve "crosses" duct of submandibular salivary gland, at the level of the third molar lingual nerve is located under the duct and lateral to it, closer to the inner surface of the body of the mandible. At the level of the first molar lingual nerve is located above and medial to Wharton duct and passes along sublingual-lingual muscles (m.hyoglossus).

[Anatomical rationale for lingual nerve injury prevention during mandibular block]

The topographic and anatomical study of lingual nerve structural features was done. It was revealed that during mandibular anesthesia possible lingual nerve injury can occur if puncture needle is lower than 1 cm. of molars occlusal surface level. The position of the lingual nerve varies withmandible movements. At the maximum open mouth lingual nerve is not mobile and is pressed against the inner surface of the mandibular ramus by the medial pterygoid muscle and the temporal muscle tendon. When closing the mouth to 1.25±0.2 cmfrom the physiological maximum, lingual nerve is displaced posteriorly from the internal oblique line of the mandible and gets mobile. On the basis of topographic and anatomic features of the lingual nervestructure the authors recommend the re-do of inferior alveolar nerve block, a semi-closed mouth position or the use the "high block techniques" (Torus anesthesia, Gow-Gates, Vazirani-Akinozi).

[Scientific anatomical rationalefor lower teeth local anesthesia]

The article presents clinical recommendation for the choice of local anesthesia techniques in dental treatment of lower teeth based both on original research and literature review. Several localanesthesiatechniques are described for various teeth group, as well as intraosseousdiffusionoflocal anesthetic at various sites of mandible bone and possible anatomical reasons for local anesthesia failures. Theresultsofauthor's anatomical and clinical studies confirm that branches of buccal and lingual nerve can provide lower teeth innervation. Several local anesthesia techniques which may be useful for overcoming the mandibular block failure are proposed.

[Indications, feasibility and clinical experience with Vazirani-Akinozi mandibular block in limiting mouth opening and difficult anatomical conditions]

Vazirani-Akinozi technique was used in 82 patient undergoing oral surgery procedures. According to study results Vazirani-Akinozi technique was feasible in 89% of cases and particularly effective in surgical treatment of third lower molars eruption diseases complicated by inflammatory contracture. The method increases mouth opening 1.6-2.3 cm due to the soft-tissue anesthesia and partial anesthesia of masseter nerve. In case of inflammatory contracture of the jaws when inflammatory infiltration is spreading on the masseter muscle the authors recommend to use a combination of Vazirani-Akinozi and Berchet-Dubov techniques.

[Practical advices in choosing local anesthesia tools in dentistry. Management of carpule's quality in local anesthesia in dentistry]

The equipment for local anesthesia is described in this article. Practical recommendations for the selection of the injection needle length, size, bevel type is given. Using dental needle for local anesthesia should be guided by the "one injection - one needle" rule, as a needle tends to deform by even the slightest contact with jawbone. Some of the shortcomings of carpule quality may be detected before use: signs of cup corrosion, the presence of sediment, air bubbles, rubber plunger disposition. In the case of such defects being identified all the package should not be used. The use of such carpule in clinical practice is unsafe.

[Retromolar mandibular anesthesia. Radiological and topographical study of an additional method of lower teeth anesthesia]

The aim of the study was to estimate the clinical efficacy of mandibular third molars anesthesia with various combinations of local anesthesia methods. Anatomical, radiological and morphological methods were used in the study. The topographic features of retromolar triangle were thoroughly examined. The neurovascular bundle revealed its relationship with retromolar area structures. According to the results of the clinical study the most effective combinations of mandibular third molars analgesia were selected.

[Anatomical and radiological studies on additional mandible teeth anesthesia considering innervation variability]

The paper presents studies on nutritional foramina of the mandible. Some nutritional foramina located in the frontal mandibular region on the lingual surface and containing significant blood vessels and nerves are found to be more typical for teeth-bearing mandible. In retromolar area in case of third molars presence intraosseous canals were revealed leading to inferior alveolar nerve canal. One should consider intraligamental and lingual anesthesia by lower incisors extraction. Intraosseous anesthesia and retromolar area infiltration significantly increase anesthesia efficiency by third molar extraction.

[Optimization of treatment hard tissue defects of the tooth located near gingiva]

Defects near gingiva--a common pathology of dental hard tissue, which adversely affects the health of marginal periodontium. Subgingival tooth cavity is the retention factor for parodontopatogenic microorganisms. Chronic inflammation in the marginal periodontium in response to microbial invasion may lead to local periodontitis (periodontal pocket/gingival recession). Treatment of defects near gingiva should include the removal of the main etiological factors of disease: supraocclusion, bad habits, normalization of individual oral hygiene. Substitution therapy is the defect filling. The most suitable filling material on physicochemical and mechanical properties of composite recognized. Treatment of gingival defects is carried out after surgical correction of gingiva. Optimal conditions are achieved using the sealing hemostatic and retraction paste.