Background. Over the past 20 years, the prevalence of wedge-shaped defects has increased by 14%, and in some countries of the world it reaches critical values ​​- 82%. At the same time, the treatment of this pathology is carried out at the later stages of its development with excision of the hard tissues of the tooth and subsequent restoration, without taking into account the initial macro- and microstructural changes in the enamel. The purpose of our study was an experimental in vitro study of anatomical and morphological features of the tooth enamel structure, its qualitative and quantitative composition in the initial forms of a wedge-shaped defect. Materials. As the material for our study we used intact teeth removed for orthodontic indications and with initial forms of a wedge-shaped defect of classes 1 and 2 according to the classification of Shevelyuk Yu.V., Makeeva I.M. (2011), subsequently 63 sections were made out of these teeth. Methods: clinical, experimental, scanning electron microscopy and energy dispersive analysis, statistical, analytical. Results. Structural transformations of enamel were revealed in the initial forms of the wedge-shaped defect, the boundaries of the lesion were determined, and morphological changes were established in the tissues adjacent to the lesion involved in the pathological process against the background of quantitative and qualitative indicators of its chemical composition. Conclusion. a comparative analysis of the enamel microstructure in normal and wedge-shaped defects confirms the heterogeneity of the lesion and the transformation of the chemical, quantitative and qualitative composition of the enamel.

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This study proves the necessity of using new minimum intervention tooth-preserving technologies and their implementation methods in hard dental tissue pathology treatment, in particular, wedge-shaped defects within enamel. Personalized approach to choosing the treatment method for this type of pathology is updated. The study prioritizes the pathogenetic mechanisms of this process, taking into account morphofunctional changes in enamel. Changes in architectonics of tooth enamel and its elemental composition are studied and discussed. A method of delivering the medication directly into the lesion is suggested. The objective of this study was to develop a precision device for targeted delivery of medication and creation of isolated reservoirs in the wedge-shaped lesion. Materials: slices of teeth removed due to orthodontic indications. Methods: experimental, analytical, statistical, sociological, electron microscopy. The scientific basis and principles of the research concept are based on the data on microstructural transformations, changes in the elemental composition of the tooth with a wedge-shaped defect. It is proved that oxygenation increases in a wedge-shaped lesion while the amount of fluorine and carbon compounds decreases, leading to the presence of such non-specific microelements as sulfur. The results obtained are the basis for the application of a targeted and personalized algorithm for treating this pathology, using additive technologies and 3D printing

The article is devoted to the influence of «self-made dezomorhine» on pyo-inflammatory disease of maxillofacial area. This project is topical in Russian Federation, because the quantity of drug addicts grows every year. Maxillofacial area is a high-risk zone for development of inflammatory process due to the high probability of the chronic odontogenic center of infection and because of special aspects of blood supply and innervation of this area. Special attention must be payed to the jaws osteonecrosis of the jaws, which develop after «self-made dezomorhine» ingestion. Dezomorhine is a narcotic analgesic, which is banned in Russian Federation. From 2008 to 2014 there was conducted the treatment of 84 patients from age19 to 55 years of both sexes with local and diffuse osteonecrosis of the jaws, which began after «self-made dezomorhine» in department of maxillofacial surgery of Astrakhan Aleksandro-Mariinskaya Regional Clinic Hospital, 2 patients of the whole number of operated patients died because of the overdose of drugs. One patient died due to the septic accident during the period of monitoring. It was found because a result of retrospective analysis post evaluation procedures make it possible to affirm, that if the operation was performed in the course of 6 months after the intermission of taking drugs, the necrotic process usually extends to nearby areas of the jaws after the implementing of the necroectomy. The best results of the treatment were achieved when patients applied for hospital treatment after 6 to 12 months following the intermission of taking of «self-made dezomorphine». The article deals with 2 medical cases, illustrated by X-Ray pictures and clinic photos. 205 operations were performed by the 6 years’ experience of the treatment of 84 patients with «dezomorphinic» osteonecrosis of the jaws and it enables us make a conclusion, that classic surgeon treatment is the most preferable variant. The classic treatment includes surgery after the appearance of demarcation zone and sequesters organization. The detoxication therapy, immune-enhancing therapy, anemia treatment and usage of antibiotics are the important parts of the treatment, as well as the antibiotic use. Provided the specific microflora and typical status of immune system phenomenon occurred in the process of complex treatment of «dezomorphinic» necrosis of the jaws, we, applied a course of semisynthetic macrolides. We mostly applied Roxithromycinum in a dose of 150 mg in tab. 2 b.d.s. with the interval of 12 hours; period of treatment lasts 5 days. Rational antibiotic treatment allows prognosticating a successful result of the treatment of «dezomorphinic» osteonecrosis of the jaws.