[Analysis of claims to conclusions of forensic medical examinations in legal proceedings relating to personal injury during dental treatment]. / Analiz pretenzii k zaklyucheniyam sudebno-meditsinskikh ekspertiz v sudebnykh protsessakh, kasayushchikhsya prichineniya vreda zdorov'yu pri stomatologicheskom lechenii.

OBJECTIVE: To analyze the quantitative and qualitative composition of main claims from proceeding parties, submitted to the conclusions of forensic medical examinations, based on appellate complaints from trial participants and associated with personal injury as a result of dental treatment. MATERIAL AND METHODS: The judgment materials for the period from 2013 to 2022 yrs. were examined. RESULTS AND CONCLUSION: The multiple increase in the claims frequency to the absence of normative references in experts' conclusions (from 5.7% in 2013-2017 yrs. to 32.2% in 2018-2022 yrs.) and answers on the presence of causal link (from 1.8% in 2013-2017 yrs. to 22.6% in 2018-2022 yrs.), as well as to ignoring the findings of other independent experts (from 7.9% in 2013-2017 yrs. to 19.1% in 2018-2022 yrs.), to the lack of documentation on used examination methods in research part (from 4.4% in 2013-2017 yrs. to 20.9% in 2018-2022 yrs.), to production of expert evidence without patient's observation (from 6.1% in 2013-2017 yrs. to 12.2% in 2018-2022 yrs.) and to a number of other issues, requiring a new approach to develop a system of internal quality and safety control for forensic medical examinations, have been revealed.

[X-ray evaluation of the design features of stump pin tabs]. / Rentgenologicheskaya otsenka osobennostei konstruktsii kornevykh shtiftovykh vkladok v prakticheskoi stomatologii.

OBJECTIVE: Carrying out an objective assessment of the quality of performance of the technique of prosthetics with stump pin tabs of the upper and lower molars. MATERIALS AND METHODS: A retrospective assessment of the quality of dental preparation and modeling of root pin inlays was carried out by analyzing CBCT studies using the RadiAnt program. Measurements were carried out and 80 CBCT studies of patients who had tabs in their molars performed in various clinics of the city of Moscow were studied. RESULTS: Restoration of defects in the hard tissues of teeth with cast root pin tabs has specific features related to the anatomy of the roots and the distribution of the chewing load. An analysis of the practical implementation of the prosthetics technique and the compliance of the quality of the tabs with the requirements of clinical recommendations showed that they are performed only in 47.5% of cases with respect to modeling the length of the pin part of the tabs (relative to the length of the tooth root), in 40.0% of studies - on the quality of root canal filling; in 36.3% - on the residual thickness of the walls of the tooth root. The requirements for the ratio of the foliar and pin parts of the tabs were not met in any of the cases. In the case of tab modeling, the requirements for maintaining a safe zone in the area of root furcation and tooth tissue thickness of at least 1.0 mm were met only in 36.25 (32.50±3.75)% of cases. CONCLUSION: Improving the quality of prosthetics using tabs lies not only in the plane of a more responsible approach to determining indications for this type of prosthetics, performing techniques and algorithms, using modern tools, but also in the field of working out the methodology for manufacturing tabs in multi-root teeth taking into account the anatomy of the roots of chewing teeth, the distribution of chewing pressure and the number of pin parts of tabs.

[Analysis of the forensic medical examinations features in dentistry based on the study of judicial practice for 2013-2022]. / Analiz osobennostei sudebno-meditsinskikh ekspertiz po stomatologii na osnovanii izucheniya sudebnoi praktiki za 2013­2022 gg.

During the study of forensic medical examinations conducted in 2013-2022 in cases related to poor-quality dental care, the main features of the implementation of expert assessments were identified. The most common (in 46% of cases) assessment of comprehensive dental care is carried out. In 6% of cases, claims are made to 2-5 medical organizations at once. In 15-20% of cases, during the forensic medical examination, the condition in the oral cavity has already been changed by subsequent dental treatment. In the course of the study, it was determined that payments from dental organizations are on average 10 times higher than the cost of treatment and account to about 40% of the amounts requested by patients in claims. In 15% of cases, forensic medical examination was carried out on dental care provided within the framework of state guarantees of free medical care. Claims for compensation for moral damage were contained in 97% of cases, in 56% of cases the court confirmed their validity. The growth rate of cases where claims for compensation for moral damage were satisfied for 10 years amounted to 36%. The amount of compensation payments has increased. The revealed features of judicial practice in dentistry necessitate the development of objective, evidence-based, reproducible assessments and the introduction of evaluation criteria in clinical recommendations for the relevant nosology.

[Analysis of compensation payments for moral damage in cases related to poorly provided dental care (2013-2022)]. / Sravnitel'nyi analiz vyplat kompensatsii moral'nogo vreda po delam, svyazannym s nekachestvenno okazannoi stomatologicheskoi pomoshch'yu (2013­2022 gg.).

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.

[Orthopedic rehabilitation of patients in the department of Modern Prosthetics Technologies of the Central Research Institute of Dentistry and Maxillofacial Surgery]. / Ortopedicheskaya reabilitatsiya patsientov v otdelenii sovremennykh tekhnologii protezirovaniya FGBU NMITs «TsNIIS i ChLKh¼.

The main guidelines for innovative prosthetic technologies and effective methods for replacing defects in hard tissues of teeth and dentitions in patients with pathological abrasion of teeth, secondary deformations of dentitions and generalized periodontitis are implemented in the department of modern prosthetics technologies through the introduction of digital technologies (3D modeling, scanning, printing), development of new methods and techniques of treatment, study of the features of reparative regeneration in the field of dentition defects and changes in the prosthetic bed, analysis of morphological changes in traumatic occlusion, integration with other clinical departments of the institute.

[Internal control of the quality and safety of medical activities in the field of information interaction between patient and medical organization]. / Vnutrennii kontrol' kachestva i bezopasnosti meditsinskoi deyatel'nosti v sfere informatsionnogo vzaimodeistviya patsienta i meditsinskoi organizatsii.

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.

[The role of dental medical records in the assessment of the quality of medical care]. / Rol' meditsinskoi karty stomatologicheskogo bol'nogo pri ekspertizakh kachestva okazyvaemoi meditsinskoi pomoshchi.

The influence of the quality of registration of medical records in the provision of dental care to the possibility of objective evaluation of the quality of treatment in forensic examinations. The structure of complaints that became the basis for 432 patients' appeal to the court, the frequency of occurrence and the qualitative composition of questions to expert doctors are determined. It is proved, that the medical record of a dental patient is one of the main proofs in the judicial process when justifying the position of the parties: 81% of legislative examinations contained questions about compliance with clinical recommendations and treatment standards, and 69% about the presence of defects and shortcomings of treatment. Analysis of the quality 1530 of dental records in various regions of the Russian Federation showed that only 77.8±1.06% of the records contained a detailed description of the course of surgery, a description of additional diagnostic methods was present in 70.6±1.16%, and an informed consent to surgery in 15.3±0.91% of the records. Unqualified filling out of the medical record is currently regarded as poorly provided medical care so it is necessary to change the attitude of dentists to filling out medical documentation.

[Development of criteria for creating an electronic medical record of a dental patient]. / Razrabotka kriteriev dlya sozdaniya elektronnoi meditsinskoi karty stomatologicheskogo bol'nogo.

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.

[Implementation of obligatory medical insurance programs in dentistry based on the cost of relative unit of labor intensity]. / Otsenka realizatsii programmy obyazatel'nogo meditsinskogo strakhovaniya po razdelu «Stomatologiya¼ na osnove stoimosti uslovnoi edinitsy trudoemkosti.

THE AIM OF THE STUDY: Was to analyze financial feasibility of obligatory medical insurance programs in dentistry based on the cost of relative unit of labor intensity. MATERIAL AND METHODS: The study is based on statistical analysis of service types and costs dynamics in dental obligatory medical insurance programs in Russia in 2013-2018. RESULTS: The study identified trends in financing health care, government guarantee programs and financial costs per 1 unit of labor intensity, which should be taken into account when making a medical and economic feasibility study of basic and territorial government guarantee programs to provide citizens of the Russian Federation with free medical care and planning the dental section of the compulsory medical insurance program. CONCLUSION: The financial possibilities of implementing the compulsory medical insurance program in the field of dentistry in the Russian Federation are limited by reducing the cost of dental services from the total amount of healthcare financing, not proportional to the increase in inflation and the level of expenses for the compulsory medical insurance program, aggravation of the pathology of patients and untimely treatment for dental services. The provision of planned dental services and preventive measures will reduce the financial costs of these services.

[Development of an expert assessment of the quality of dental care]. / Razrabotka ekspertnoi otsenki kachestva stomatologicheskoi pomoshchi.

The article proposes a methodology for creating an assessment of the quality of dental care based on the use of the method of analysis of hierarchies and the theory of fuzzy logic. Approbation of the methodology was carried out on the assessment of the quality of dental services for the manufacture of metal-ceramic crowns. When conducting a new assessment, you can achieve a reduction in the time of its conduct by 6 times, increasing the number of evaluation criteria by 2 times and get results with a confidence factor (p=0.95). Evaluation allows you to combine existing descriptive, quantitative, radiological, functional assessments into a system and rank their significance for the final result. This allows assessing the quality of treatment more objectively.

[The readiness of restorative dentistry departments for the implementation of modern technologies]. / Analiz gotovnosti stomatologicheskikh ortopedicheskikh otdelenii k ispol'zovaniyu sovremennykh tekhnologii.

The study showed the presence of negative dynamics in the provision of population with orthopedic dentists and dental technicians, as well as a decrease in the staffing of medical organizations with these specialists. The fact of exceeding the basic rate of loss of dental technicians over the same indicator for dentists-orthopedists by 2 times was established. The possibility of increasing the availability of personnel by combining positions is revealed, since the coefficient of concurrency among dentists-orthopedists and dental technicians is less than the average for the specialty. The trends of decreasing interest of specialists in obtaining qualification categories are noted. According to the survey of 305 specialists, a model of the most probable structural «profile¼ of a dentist-orthopedist was created and the characteristic features of the learning processes and practical use of knowledge on the main new technologies in orthopedic dentistry were determined. The data obtained in the course of the study indicate that there are limited opportunities to improve the availability and quality of dental orthopedic care and the introduction of new prosthetics technologies.

[Regulatory framework of the new system of wage payment in research institutions]. / Osnovy novoi sistemy oplaty truda v nauchno-issledovatel'skikh institutakh.

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.

[The labor regulation of restorative dentists]. / Normirovanie truda vrachei stomatologov-ortopedov.

The study of regulatory legal documentation indicates that the labor standards of dentists-orthopedists are not approved at the state level. The current technical-organizational and medical conditions activities of these specialists have led to the need to establish the existing norms of the workload and the development of modern normative documents on work of dentists-orthopedists.

[Risk-based approach to the organization of dental implantological care based on judicial practice]. / Vozmozhnosti ispol'zovaniia risk-orientirovannogo podkhoda v organizatsii stomatologicheskoi implantologicheskoi pomoshchi s uchetom dannykh sudebnoi praktiki.

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.

[General strategy for the development of dental laboratories with CAD/CAM systems]. / Obshchaia strategiia razvitiia zubotekhnicheskikh laboratorii, osnashchennykh CAD/CAM-sistemami.

The need for the practice of dentistry in the digital (CAD/CAM) technologies have initiated the emergence of dental laboratories as a separate and independent legal entities. The choice of a strategy for the development of these laboratories is aimed at ensuring the achievement of the main goals in the long term. It is established that the type of innovation in terms of 'Shake test' J. Daya, in these organizations can be designated as an option 'C' - a strategy of gradual conquest of the market. The main components of the development are: work with staff, information support, financial optimization; material and technical support, marketing activities, organizational and legal support, the formation of the quality system.

[Organizational and legal aspects of implant dentistry according to the analysis of judicial practice]. / Organizatsionno-pravovye aspekty okazaniia stomatologicheskoi pomoshchi s primeneniem implantatov s uchetom analiza sudebnoi pravoprimenitel'noi praktiki.

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.

[The role of clinical recommendations in ensuring the quality of care in dental implantation]. / Rol' klinicheskikh rekomendatsii v obespechenii kachestva stomatologicheskoi pomoshchi pri dental'noi implantatsii.

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.

[Compensation of moral harm caused by poor quality of dental care]. / Kompensatsiia moral'nogo vreda, prichinennogo v rezul'tate nekachestvennogo okazaniia stomatologicheskoi pomoshchi.

The study presents a review of the legislative regulation of compensation for moral damage in case of poor medical dental care and judicial practice according to the types of civil cases for 25 years as well as the main tendencies of existing court dental practice and the long-term trends.

[The analysis of the judicial practice of treating the civil lawsuits concerning the inadequate dental health service appeals launched by the patients in the Russian Federation during the period from 1993 to 2017]. / Analiz sudebnoi praktiki po grazhdanskim delam, sviazannym s defektami okazaniia stomatologicheskoi pomoshchi naseleniiu Rossiiskoi Federatsii za period s 1993 po 2017 g.

The objective of the present study was to elucidate the characteristic features and peculiarities in the dynamic of the civil legal proceedings concerning the quality of the stomatological aid to the population of the Russian Federation during the period from 1993 to 2017. We have undertaken the analysis of the official sources containing the court reports on the statements of claim launched by the patients. The study gave evidence of the currently well apparent sustained tendency toward the increase in the number of such civil lawsuits. The probabilities of legal proceedings in connection with the unfavourable outcomes of the dental treatment are roughly identical in all areas of the stomatological practice. The maximum number of the respective civil lawsuits arise from the claims of the patients against the dental surgeons employed by the healthcare settings designated as the limited liability companies. The majority of the statements of case coming from the patients contain the demanding financial claims for the compensation of the moral damage. It is concluded that the aforementioned tendencies in the strategy of the development of the stomatological aid for the population of the Russian Federation dictate the necessity of the priority development of the quality standards (including the clinical guidelines, protocols, etc.) designed to improve the medical assistance for the patients presenting with dental problems, the modernization of the validated methods for the evaluation of the effectiveness of the stomatological aid for the population, the implementation of the measures needed to introduce the mechanisms of professional liability insurance into the routine stomatological practice. These measures are believed to allow to meet the demand of the population of this country for the high-quality stomatological services.

[Legislative regulatory framework for medical care quality and safety control]. / Normativnaia pravovaia baza, reglamentiruiushchaia kontrol' kachestva i bezopasnosti meditsinskoi deiatel'nosti.

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.