[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.

[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.

[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.

[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.

[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.

[Foreign body in the esophagus as a reason to assess the medical aid quality during the forensic medical examination]. / Inorodnoe telo pishchevoda kak povod dlya ustanovleniya pravil'nosti okazaniya meditsinskoi pomoshchi pri proizvodstve sudebno-meditsinskoi ekspertizy.

THE AIM OF THE STUDY: Was to investigate in detail the case of a combination of esophageal injury and aortic aneurysm from the standpoint of the perspective of medical care. It was established that the circumstances of the improper provision of medical care in this case were the subjective nature in the form of insufficient and incorrect provision of it. It is shown that continuous training of doctors and mid-level medical workers within the continuing medical education is a gurantee of proper medical care.

[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.

[The effectiveness of tooth-preserving surgery in various forms of inflammatory and destructive lesions in mandibular molars area]. / Éffektivnost' zubosokhraniaiushchikh operatsii pri razlichnykh formakh vospalitel'no-destruktivnykh protsessov v oblasti moliarov nizhnei cheliusti.

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.

[Needle fractures during mandibular block: prevention and emergency care algorithm]. / Perelom in''ektsionnoi igly pri mandibuliarnoi anestezii: algoritm profilaktiki i lecheniia.

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.

[Anatomic rationale for clinical efficacy of intraosseous mental nerve anesthesia]. / Anatomicheskoe obosnovanie klinicheskoi éffektivnosti provodnikovoi anestezii vnutrikostnoi chasti podborodochnogo nerva.

The aim of the study was to prove the anatomical and clinical effectiveness of the modified anesthesia of mental nerve. The effectiveness of conductive anesthesia near the mental foramen was objectively evaluated using the electric pulp test (EPT) in 100 volunteers of both sexes, aged 35-43 years. Wet anterior mandible preparations obtained from 350 cadavers aged 18-74 years were also studied. EPT value after local mental anesthesia conducted according to Malamed C. using 4% articain solution of local anesthetic with vasoconstrictor concentration of 1:200.000 after 2 minutes was 93±0.82 mA, after 4 minutes - 188±1.26 mA. Yield variability indicators of intraosseous mental nerve anesthesia was slightly higher varying from 94.11 mA to 96.61 mA after 2 minutes and from 197.4 to 199.92 mA after 4 minutes survey. The study showed the efficiency and predictability of intraosseous anesthesia of the mental nerve.

[The diagnostic potential of computed tomography for the purpose of forensic medical examination of a craniocerebral injury]. / Diagnosticheskie vozmozhnosti komp'iuternoi tomografii pri sudebno-meditsinskoi ékspertize cherepno-mozgovoi travmy.

The authors make use of the data borrowed from the special literature and the results of their original investigations to carry out the comparative analysis of the materials of the intravital X-ray studies and post-mortem examinations. Special attention is given to the possibilities available at the present time for making virtopsies in the cases of the craniocerebral injury.

[Dental care for patients at risk of adverse reaction to local anesthetics]. / Stomatologicheskaia pomoshch' patsientam s riskom razvitiia pobochnykh reaktsii na mestnye anestetiki.

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.

[Determining the prescription of brain injuries based on the changes of the nucleolus organizer in astrocytes]. / Opredelenie davnosti povrezhdenii golovnogo mozga po izmeneniiam iadryshkovogo organizatora v astrotsitakh.

The well apparent signs of the proliferative reaction and activity of the nucleolus organizer in astrocytes within the zone of injury and at its periphery are considered to be the indicators of the participation of these cells in all the phases of the inflammatory and reparative processes associated with the brain injury. The objective of the present study was the evaluation of the changes in the number of the nucleoli in the nuclei of astrocytes during the acute post-traumatic period following the craniocerebral injury. A total of 26 cases of death of the men and women at the age from 36 to 50 years caused by the craniocerebral trauma were available for the examination. The tissue samples were stained with hematoxylin and eosin, based on the use of the Perls' Prussian blue staining protocol or by means of the AgNOR staining technique. The astrocytes in the regions immediately adjacent to the sites of brain injury were shown to undergo areactive necrosis during the first hours after the damage had been inflicted. The evaluation of the changes in the astrocytes required taking into consideration the influence of autolysis on the character of the signs being identified. The increase of the number of points in the astrocytes in which RNA replication occurs within days 2-4 after the injury can be accounted for by the accumulation of the granules containing silver in the cell nuclei. The cross reactions between hemosiderin and RNA await further investigations. It is concluded that the methods employed in this study may be of diagnostic significance for the purposes of forensic medical histology if used in the combination with other specialized techniques for determining the prescription of the craniocerebral injuries. The combination of the morphological and functional studies opens up the promising prospects for the investigations into the necrotic and proliferative processes in astrocytes associated with brain injuries of different origin.

[Legal and regulatory framework prevention of infections, associated with delivering of medical care].

Legal and regulatory framework for prevention of infections, associated with delivering of medical care. Preventing infections associated with delivering of medical care suggests the organization of preventive and anti-epidemiological measures with the use of modern regulatory framework, which has undergone significant changes and continues to improve in recent years. The new data on clinical, epidemiological, social and economic effectiveness of the activities of this trend in organizations engaged in medical activities. The current and constantly updated system of normative, legal and methodological documents allows organizing an effective protection of patients and medical staff from nosocomial infections. The article provides an overview of existing regulations in the field of prevention of infections associated with health care, the possible ways of its improvement.

[Clinical and radiological features of inflammatory lesions in the lower molars area]. / Kliniko-rentgenologicheskaia kharakteristika vospalitel'no-destruktivnykh protsessov v oblasti moliarov nizhnei cheliusti.

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.

[Ways of improvement of military epidemiology as a diagnosis and prophylaxis branch of military medicine].

Ways of improvement of military epidemiology as a diagnosis and prophylaxis branch of military medicine. The prospects of development of epidemiological science, training systems and improvement of practice in preventive medicine based on the integration process are considered. The authors emphasize a final recognition of epidemiology as a single diagnostic and preventive discipline the subjects of which are manifestations of epidemic diseases regardless aetiology. An integration of specialists in prophylaxis requires correction of the system of military-medical education and improvement of preventive medical support subsystem of (naval forces). The prospects of inclusion in the educational and scientific processes of the epidemiology of non-communicable diseases, improve the interaction of different structures of military medical services in the field of infectious disease prevention personnel.

[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.