[The development of algorithm of preventive consideration of applications of citizen for stomatological polyclinics administrators].

The key priorities of the concept of development of health care in the Russian Federation is the population health support and increasing of availability and quality of medical care. The critical link in chain of interaction between medical organizations and residents is examination of applications of citizen. An appeal of citizen received by state authority, local self-government authority or by the official in accordance with their competence is to be a subject of mandatory proceeding. The service of non-staff chief stomatologist based on the organizational methodical office of Moscow Oblast Stomatological Polyclinic the comprehensive analysis of appeals of citizen appeals regarding provision of medical care in stomatological polyclinics of the Moscow Oblast was carried out. The analysis of summary of tasks demonstrated that in 2020, 107,511 appeals of citizens were received and 1002 tasks were related to stomatological care support that accounts 0.93% of total number of appeals. The results of analysis permitted to elaborate a set of recommendations for administrators of stomatological medical organizations to improve quality of examination of appeals of citizen.

[Diagnostic value of biomarkers of bone metabolism in the gingival fluid in inflammatory-destructive and tumor oral pathology]. / Informativnost' otsenki biomarkerov kostnogo metabolizma v desnevoi zhidkosti pri vospalitel'no-destruktivnoi i opukholevoi patologii v polosti rta.

OBJECTIVE: The aim of the work was to determine the informativeness of the assessment of biochemical markers in the gingival fluid with destructive bone changes in the peri-implantation area, primary tumor lesion of the alveolar processes of the jaws and metastatic destruction of the jaw bone tissue in cancer of the large salivary glands. The study included 51 patients aged 30 to 75 years of both sexes. Depending on the genesis of destruction of the bone tissue of the lower jaw, three groups of patients were identified. Group 1 - 20 patients with peri-implantitis. Group 2 - 22 patients diagnosed with cancer of the oral floor mucosa (ICD C04) with erosion of the cortical bone or dental socket by a primary tumor. Group 3 - 9 patients with adenocarcinoma of the large salivary glands with metastatic lesions of the lower jaw. 15 people were practically healthy persons without periodontal pathology. The test material was gingival fluid or exudate from peri-implantation pockets. The content of cathepsin K, tartrate-resistant acid phosphatase (TAP) was determined by the enzyme immunoassay, and the bone fraction of alkaline phosphatase (BAP) was determined by the kinetic method. RESULTS: As a result, it was found that in group 1 in the exudate of the peri-implantation sulcus, the content of cathepsin K increased in comparison with the control by 2.5 times (p<0.05), TAP by 1.6 times (p<0.05). in groups 1 and 2, there was a moderate increase in the production of activated osteoblasts of KAP. In cancer of the mucous membrane of the floor of the mouth, a tenfold increase in the concentration of cathepsin K and TAP in the gingival fluid was observed. With metastatic lesions of the jaw in patients with adenocarcinoma of the large salivary glands, along with a multiple increase in the concentration of cathepsin K and TAP in the gingival fluid, there was a twenty-fold increase in the bone formation marker BAP, which indicated a mixed type of metastases and was a differential diagnostic criterion for metastatic lesion of bone tissue in comparison with the primary metastatic lesion of bone tissue. CONCLUSION: Thus, biochemical markers are sensitive indicators of remodeling of bone tissue both in local inflammatory and destructive processes in peri-implantitis and in primary and metastatic tumor lesions of the jaws.

[COMPREHENSIVE ASSESSMENT OF THE SPECIES COMPOSITION AND SENSITIVITY OF MICROFLORA IN PATIENTS WITH ODONTOGENIC MAXILLARY SINUSITIS].

Objective - to study the species composition of microflora and its sensitivity in patients with odontogenic maxillary sinusitis. The study included 230 patients of both sexes aged 18 to 70 years, who were treated at the Moscow Regional Scientifics Research and Clinical Institute named after M. F. Vladimirsky with a diagnosis of Odontogenic maxillary sinusitis. Of these, there were 155 patients with odontogenic sinusitis, complicated by perforation of the maxillary sinus and the presence of an oro-antral fistula, and 75 patients with maxillary aspergillosis. All patients underwent microbiological examination of smears and flushes from the maxillary sinus cavity with the determination of the species composition and antibiotic sensitivity. In the majority of the patients with perforative forms of odontogenic maxillary sinusitis, coccal flora (streptococci and various species) was detected, in a smaller number compared to it - facultative and obligate anaerobes, pathogenic fungi (Candida). A comparative analysis of the microflora, depending on the duration of the maxillary sinus perforation, showed that the rhinogenic microorganisms (Moraxella spp.) were found only in intraoperative perforations (up to 20% of cases). The presence of obligate anaerobes (Fusobacterium spp. Bacteroides spp.) was typical for long-existing perforations. In patients with maxillary aspergillosis facultative and obligate anaerobes were found less frequently and in a smaller variety than in patients with perforative maxillary sinusitis. There were no cases of sinus contamination by pathogenic fungi of the genus Candida in this group. At the same time, rhinogenic microgranisms (Moraxella spp.) were detected with a higher frequency (up to 27.3%) in this group of patients.

[DENTAL CARE FOR MOSCOW REGION CITIZENS IN THE CONDITIONS OF THE COVID-19 PANDEMIC (APRIL-JUNE 2020)].

It is known that the oral cavity is an epidemiological hazard due to the high level of viral and bacterial contamination. Despite the narrow specialization and distant connection with the problem of viral pneumonia, dentists, nevertheless, are at risk of contracting the new coronavirus infection COVID-19. To reduce the epidemiological activity the provision of routine dental care was suspended in the vast majority of regions of the Russian Federation including the Moscow region, from the end of March 2020 to June 20, 2020. During the entire period of routine medical care suspended, the Moscow region chief dentist's team was daily monitoring information about applied patients. The suspension of routine medical care has reduced the number of cases of COVID-19 infection contact transmission in medical organizations during the period of the most active increase in the morbidity. In addition, the decrease in the number of patients enabled medical organizations to reduce the number of medical personnel, which contributed to a decrease in the percentage of morbidity among doctors.

[Diagnostic possibilities of laboratory assessment of cathepsin K activity in gingival and peri-implant fluid under normal conditions and periimplantitis]. / Diagnosticheskie vozmozhnosti laboratornoi otsenki aktivnosti katepsina K v desnevoi i periimplantatsionnoi zhidkosti v norme i pri periimplantite.

OBJECTIVE: The aim of the work was to develop a non-invasive laboratory method for local control of the severity of osteo-destructive processes in the bone tissue of the jaws after dental implantation. MATERIALS AND METHODS: The study comprised 75 individuals aged 18 to 65. The main group included 40 patients with a diagnosis of dental periimplantitis (ICD K 10.2). A comparison group (n=20) included patients after dental implantation without postoperative complications. The control group (n=25) consisted of individuals without dental pathology. Cathepsin K (CTSK) (Human) ELISA Kit (Cloud-Clone Corp., USA) was used to determine the concentration of cathepsin K by the enzyme immunoassay in the gingival or peri-implant fluid. RESULTS: The concentration of cathepsin K in the gingival fluid in the patients of the control group was 1.7±0.3 pmol/l, in the comparison group the concentration of the studied biomarker corresponded to 2.3±0.4 pmol/l. In the main group, the concentration of cathepsin K in the exudate of peri-implantation pockets increased 2.8 times (p<0.05) and corresponded to 4.9±0.5 pmol/l. The concentration of cathepsin K in the gingival fluid normally did not depend on age and gender, which increased the independence of the osteomarker for characterizing the osteoresorbent process in the peri-implantation area. After dental implantation, an excess of cathepsin K concentration above the level of 2.7 pmol/l with a diagnostic sensitivity of 82.5% and a specificity of 83.7% suggests a high risk of developing peri-implantitis. CONCLUSION: The concentration of cathepsin K may be seen as valuable marker for local inflammatory and destructive processes in the contents of the peri-implantation area.

[Clinical and economical aspects of a social support program for the free making and repair dentures in the territory of the Moscow region for 2016-2018].

The Government of the Moscow Region has approved more than 120 different social support measures for residents of the Moscow Region. Their aim is to help disadvantaged groups. The social support program of making and repair dentures for Moscow region residents provides preservation of dental health and restoration of masticatory effectiveness. A retrospective analysis of program implementation for the period from 2016 to 2018 showed an increase of 19% in the average cost of treatment. We found a correlation between the cost of conventional unit of labor and the exchange rate, an increase in the salaries of doctors and nurses, and tariffs for utilities. Planning the subsidies allocated for the implementation of social support measures is an extremely laborious and responsible process, therefore, proper financing requires taking into account all existing factors affecting the economic situation in the context of not only the Moscow Region, but also the Russian Federation.

[Hypoxia-dependent transcriptional control of activity of destructive inflammatory and malignant periodontium changes]. / Gipoksiya-zavisimyi transkriptsionnyi kontrol' aktivnosti destruktivnykh izmenenii parodonta vospalitel'nogo i zlokachestvennogo geneza.

The aim of the study was to evaluate the diagnostic value of determining the level of hypoxia-inducible factor-1α (HIF-1α) in the gingival fluid in patients with chronic generalized periodontitis (CGP) and exacerbation of inflammatory periodontal diseases in patients with cancer of the oral mucosa (OM). A clinical study was carried out with the participation of 60 patients with CGP (group 1) and 22 patients with cancer of OM (group 2) of the T1-2N0M0 stage, as well as 15 healthy individuals with no revealed periodontal pathology. CGP patients, depending on the depth of periodontal pockets (PC), were divided into two subgroups - with a mild degree (PC depth up to 3.5 mm) and an average degree (PC depth from 4 to 6 mm). Group 2 patients were also divided into two subgroups - with exacerbation of CGP (n=12) and patients with no complications (n=10). The content of HIF-1α in the gingival fluid was determined by enzyme immunoassay. The results of the study made it possible to establish that in patients of group 1, the concentration of HIF-1α in inflammatory exudate increased by 2.4 times (p<0.001) compared with the control group. The concentration of HIF-1α in the contents of periodontal pockets in patients with CGP depended on the severity of the disease: with mild CGP, it did not differ from the control group, and with moderate CGP it was 3.15 times higher (p<0.001). In patients with cancer of OM, the concentration of HIF-1α in the gingival fluid did not depend on the presence of inflammatory periodontal lesions and was determined by a multiple increase in the biomarker level (7.5 times) due to the development of a malignant process in the oral cavity. Therefore, monitoring the concentration of HIF-1α in the gingival fluid is informative in patients with CGP in assessing the severity of periodontal conditions, as well as in differential diagnosis with malignant formations of the oral cavity.

[Osteoimmunological aspects of periodontal inflammatory destructive changes at periimplantitis, chronic periodontitis and oncological diseases of the oral cavity]. / Osobennosti osteoimmunologicheskikh aspektov osteorezorbtsii pri periimplantite, khronicheskom parodontite i rake al'veolyarnogo otrostka i al'veolyarnoi chasti chelyustei.

THE AIM OF THE STUDY: Was to analyze possible correlation between the concentration of the pro-inflammatory cytokine interleukin-6 and the activation marker of osteoclasts cathepsin K in the gingival fluid during osteoresorption of inflammatory (periimplantitis, chronic generalized periodontitis) and malignant oncological origin (malignant neoplasm of gums). MATERIALS AND METHODS: The study comprised 87 individuals of both sexes aged 30 to 60: 20 patients (group 1) with periimplantitis, 30 people with chronic generalized periodontitis (CGP) (group 2), 22 patients with squamous cell carcinoma of the upper and lower alveolar bone gingiva (group 3), 15 healthy individuals without periodontal disease. RESULTS: The concentration of interleukin-6 (IL-6) and cathepsin K was determined in the gingival fluid by enzyme-linked immunosorbent assay. The examination revealed that during CGP and peri-implantitis the accumulation of IL-6 in the contents of periodontal and peri-implantation pockets was a pathogenetic factor for the activation of osteoclasts and their secretion of proteolytic enzymes osteoresorption. In cancer the increase of cathepsin K expression was a lot higher than the accumulation of IL-6 in the gingival fluid reducing the dependence of the activation of osteoclasts on the local accumulation of pro-inflammatory cytokines. Conclusion. To formulate the prognosis of progressive bone loss in patients with peri-implantitis it is necessary to control the concentration of IL-6 and cathepsin K in the peri-implantation pocket, in case of CGP the concentration of IL-6 in the exudate of the periodontal pocket and in patients with cancer of the alveolar processes the content of cathepsin K of gingival fluid.

[Implementation of early comprehensive rehabilitation of children with cleft lip and palate using the example of the Moscow region]. / Realizatsiya rannei kompleksnoi reabilitatsii detei s rasshchelinoi guby i neba na primere Moskovskoi oblasti.

Lack of early comprehensive rehabilitation of children with congenital cleft lip and palate, with age leads to aggravation of anatomical and functional disorders. Aesthetic external deformation is progressing, requiring multiple corrections. The absence of orthopedic correction in the pre-surgical period, functional correction of anatomically restored muscles in the postoperative period, exacerbates the pathology of the bite, causes persistent speech disorders. The pathology of speech adversely affects the general physical, intellectual development of the child, as well as his full adaptation in society. Problems not eliminated in childhood subsequently interfere in work and in everyday life. The patient should receive such medical care that would fill the health gap and contribute to the formation of socially significant personality traits. An integrated approach has become the only possible and only it brings optimal results. The organization of cooperation between specialists should be carried out on the basis of the Federal, Regional General Medical Profile of the medical institution.

Experimental Study of the Biomechanics of Maxillary Implants under Conditions of Biomechanical Modeling.

We studied the stress-strain state of the bone tissue and maxillary full-arch fixed implantretained denture. Load was applied to the anterior (150 N) and posterior (250 N) parts of the denture supported by 6 or 4 implants, including zygomatic ones and placed by on-all-4 treatment technology. The obtained stress values in the bone tissue, implants, and denture show a large strength margin of structural materials. At the same time, the bone strength values were low, especially around the zygomatic and distal implants of all-on-4-implants-supported dentures when the posterior part of the denture was under load.

Experimental Validation of the Efficiency of Gamalant-paste-FORTE Plus, a Russian Osteoinductive Material, in Oral Surgery.

For evaluation of the efficiency of bone substitute, nanostructurized Gamalant-paste-FORTEPlus was placed into a mandibular defect in rats. Bone tissue reparation was evaluated after 30 days by histological methods under a microscope. Use of bone substitute in experimental mandibular defect ensured more complete and rapid restructuring of the bone tissue in comparison with the control (natural healing).

[Method of multilayer assembly as alternative to antibacterial coverings of medicobiological implants].

Department of Traumatology and Orthopedics Almaty Kazakh Medical University of Continuing Education; 4. Moscow Regional Research Clinical Institute, Russia Resume: in this report we present the results on the use of the method of layer-by-layer (LbL) for obtaining antimicrobial coatings for biomedical implants. As the substrates were used silicon titanium implants and silicon plate. For the obtaining multilayer coatings on the surfaces of the samples were used as the polycation--chitosan and polyanion--carboxymethylcellulose sodium. On the surface multilayer were deposited antibacterial preparations: Triclosan-2,4,4'trichloro-2' hydroxyphenyl ether, silver ions and iodine. Microbiological studies were conducted on the museum strains: E. coli, Candida and Staf. Preliminary antibacterial studies on these microorganisms showed high activity multilayer coating containing triclosan.

[Long-term results of hemostatic sponge use by sinus-lift with simultaneous dental implantation].

The aim of the study was to assess the long-term results of using hemostatic sponge as material of choice for sinus lift with simultaneous implant placement. The results suggest this method to be clinically successful while reducing treatment coast and length.

[Computer planning of dental implantations with the use of navigational implantological sampler made by CAD/CAM technology].

Use of implantological sampler during surgical stage of dental implantations reduced considerably the number of mistakes and complications. Clinical example of planning and execution of dental implantation with the use of navigational implantological sampler made by CAD/CAM-technology with fixation upon temporary implants was brought.

[Hemomicrocirculation in oral mucosa of alveolar dental crests in cases of their considerable atrophy as determined by Doppler flowmetry].

Doppler ultrasonography was used to study hemodynamic indices of blood circulation in gingival tissues in normal conditions and in cases of parodontal diseases. Such hemodynamic parameters as linear and volumetric blood speed were determined. It was shown that hemodynamic changes in tissue blood circulation in cases of initial inflammatory diseases had moderate intensity (decrease of linear and volumetric blood speed by 22-40%). As the severity of inflammation process in parodontal tissues increased (parodontitis of medium and severe degree) and in cases of parodontosis hemodynamic changes in tissue blood circulation acquired more pronounced nature (decrease of blood speed by 56-80%).

[Long-term results and possible complications when subperiostal implants are used in patients with considerable jaw atrophy].

Analysis of the results of subperiostal implants use in 130 patients with considerable atrophy of jaws bone tissues is presented. Early and delayed complications occurring in patients after subperiostal implants use are detailed.

[Medical rehabilitation of patients with atrophic jaws]. / Meditsinskaia reabilitatsiia bol'nykh so znachitel'noi atrofiei cheliustei.

The results of this study indicate that subperiosteal implants extend the potentialities of treatment for patients with significant maxillary bone atrophy fitted with permanent dentures.