[Impacted third molar root abnormality with mandibular canal close position as a presupposing factor to inferior alveolar nerve trauma]. / Anomalii stroeniya kornei tret'ikh molyarov, tesno prilegayushchikh k nizhnechelyustnomu kanalu, kak predraspolagayushchii faktor travmy nizhnego al'veolyarnogo nerva.

OBJECTIVE: The aim of the study is reducing the risks of surgical injury to the inferior alveolar nerve, by taking into account individual topographic and anatomical features, improving diagnostic methods, and techniques for removing retinated teeth with a close fit to the mandibular canal. MATERIAL AND METHODS: An examination was conducted in the Department of Surgical Dentistry (CBCT/OPG) and surgical treatment of 223 patients, with a close fit of the roots of the retinated lower third molar to the mandibular canal. Microslips of teeth with roots intact during removal (n=96) of the main group and the control group (n=52) were prepared with a Micromet Remet manual petrographic machine. The sections were carried out along the longitudinal axis of the tooth with the capture of the area of close fitting of the nerve, the teeth from the control group were sawed longitudinally along the axis of the root. The measurement of the macroanatomic features of the roots was carried out with a micrometer (MCC-MP-100 0.001 electronic «CHEESE¼, manufactured in the Russian Federation), measurements of the thickness of dentine and cement tissues on macroglyphs were carried out using a microscope calibration ruler with an accuracy of 0.01 mm. RESULTS: In the main group, three types of attachment of the mandibular canal to the root of the third molars were distinguished: 20 (96) cases of inter-root attachment of the mandibular canal, 42 (96) apical, 34 (96) lateral (buccal and lingual). A number of anomalies in the structure of the roots of the third molars have been revealed, which are a factor in injury to the neurovascular bundle of the mandibular canal during tooth extraction. The surface of the roots, as well as the microscopes of the tooth sections adjacent to the mandibular canal, were studied under a microscope. CONCLUSION: A number of specific anomalies of the roots of retinated third molars formed by root dilaceration, thinning of cement tissues, hypercementosis, which are formed at the site of the mandibular canal.In the presence of a deep indentation on the root of the tooth, as well as in the presence of areas of apical hypercementosis in the form of a «spike¼, the probability of nerve injury during tooth extraction increases many times, which must be taken into account when removing retinated third molars.

[Microanatomy features in third molars roots adjacent to mandibular canal]. / Osobennosti anatomii kornei tret'ikh molyarov i nizhnechelyustnogo kanala pri ikh tesnom prileganii.

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 «bed¼ 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.

[Classification of lower impacted third molars position and their interrelationship with mandibular canal]. / Klassifikatsii vidov retentsii nizhnikh tret'ikh molyarov i ikh anatomicheskogo vzaimoraspolozheniya s nizhnechelyustnym kanalom.

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.

[Stafne defect as a rare anomaly of the lower jaw growth]. / Defekt Stafne ­ redkaya anomaliya razvitiya nizhnei chelyusti.

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.

[Aspiration test as dental anesthesia safety criterion]. / Aspiratsionnyi test kak kriterii bezopasnosti obezbolivaniya v stomatologii.

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.

[Surgical treatment tactics in patients with third molars located close to mandibular canal]. / Taktika lecheniya patsientov pri udalenii tret'ikh molyarov nizhnei chelyusti, prilezhashchikh k nizhnechelyustnomu kanalu.

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.

[Analysis of medical records as an element of quality control and safety of medical activities]. / Analiz meditsinskoi dokumentatsii kak element kontrolya kachestva i bezopasnosti meditsinskoi deyatel'nosti.

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.

[Severe spine lesion following alkaptonuria. Case report]. / Tyazheloe porazhenie pozvonochnika pri alkaptonurii. Opisanie klinicheskogo sluchaya.

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]. / Khirurgicheskaya taktika pri dislokatsii kornya v myagkie tkani dna polosti rta v khode udaleniya nizhnego retinirovannogo tret'ego molyara.

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]. / Obezbolivanie nizhnikh zubov u patsientov s ogranicheniem otkryvaniya rta.

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.