[Features of medical care provision in the profile «Maxillofacial surgery¼ in the Southern Federal District of the Russian Federation]. / Osobennosti okazaniya meditsinskoi pomoshchi po profilyu «chelyustno-litsevaya khirurgiya¼ v Yuzhnom federal'nom okruge Rossiiskoi Federatsii.

OBJECTIVE: To study the actual state of the organization of medical care for patients with the profile of «maxillofacial surgery¼ 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 surgery¼ 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.

[Models of bone defects in rabbits used to evaluate the bone graft materials efficacy]. / Modeli kostnykh defektov u krolikov, ispol'zuemye dlya otsenki effektivnosti kostno-plasticheskikh materialov.

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.

[Advantages and disadvantages of bone graft materials activated by BMP-2 and constructs carrying its gene]. / Preimushchestva i nedostatki kostno-plasticheskikh materialov, aktivirovannykh BMP-2 i nesushchimi ego gen konstruktsiyami.

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.

[Development of osteoplastic gene-activated 3D matrices based on adenoviral vectors]. / Razrabotka osteoplasticheskikh gen-aktivirovannykh 3D-matriksov na osnove adenovirusnykh vektorov.

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.

[Study of properties of three-dimensional matrices manufactured by antisolvent 3D printing for reconstruction of extensive bone defects in dentistry and maxillofacial surgery]. / Issledovanie svoistv trekhmernykh matrits, izgotovlennykh metodom antisol'ventnoi 3D-pechati, dlya vosstanovleniya obshirnykh kostnykh defektov v stomatologii i chelyustno-litsevoi khirurgii.

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.

[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.

[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.

[Comparative characteristics of the incidence of facial boils in military personnel and civilians]. / Sravnitel'naya kharakteristika zabolevaemosti furunkulom chelyustno-litsevoi oblasti u voennosluzhashchikh i grazhdanskikh lits.

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. 15¼ 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.

[Long-term results of dental implantation in military personnel]. / Otdalennye rezul'taty dental'noi implantatsii u voennosluzhashchikh.

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.

[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.

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.

[Orthopedic treatment of maxillary defects with the use of the residual resection prosthesis with pneumatic obturator]. / Ortopedicheskoe lechenie defektov verkhnei chelyusti s primeneniem rezektsionnogo zameshchayushchego proteza s pnevmaticheskim obturatorom.

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.

[Complications during guided bone regeneration using a membrane based on titanium thread «Titanium silk¼]. / Oslozhneniya pri provedenii napravlennoi kostnoi regeneratsii s primeneniem membrany na osnove titanovoi niti «Titanovyi shelk¼.

BACKGROUND: The titanium based membrane «Titanium silk¼ 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 silk¼. 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.

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]. / 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.

[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.

[Factors affecting osteointegration and the use of early functional load to reduce the duration of treatment in dental implantation]. / Faktory, vliiaiushchie na osteointegratsiiu i primenenie rannei funktsional'noi nagruzki dlia sokrashcheniia srokov lecheniia pri dental'noi implantatsii.

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.

[Safety and efficacy of BMP-2 and BMP-7 use in dentistry]. / Bezopasnost' i éffektivnost' primeneniia morfogeneticheskikh belkov kosti 2 i 7 v stomatologii.

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.

[Chitosan hydrogels biocompatibility improvement with the perspective of use as a base for osteoplastic materials in dentistry]. / Povyshenie biosovmestimosti khitozanovykh gidrogelei s perspektivoi ikh ispol'zovaniya v kachestve osnovy dlya kostno-plasticheskikh materialov v stomatologii.

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 ß-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.