Relevance. Rheumatic diseases strongly influence the condition of the oral cavity, salivary glands and the temporomandibular joint, that, along with poor oral hygiene in children and active growth, increases the risk of oral disease development. The growing number of rheumatic diseases in children requires evaluation of the oral cavity condition and assessment of the provided dental services; enhancement of the professional oral care in children with rheumatic diseases through the comprehensive evaluation of the quality of the performed dental procedures and development of caries prevention measures based on the analysis of the epidemiological survey results.
Materials and methods. 316 children with rheumatic pathology aged 1 to 18 years were examined. The children were divided into three age groups: group I – 1-5 years, group II – 6-12 years, group III – 13-17 years. The Oral hygiene and past dental experience questionnaire was developed for each group. Hard dental tissue condition and caries intensity level (df – in group I, df+DMF – in group II, DMF – in group III) were assessed, the oral hygiene index was calculated by the child age. On dental examination, past caries treatment and its complications were considered, the level of dental care (LDC) according to Leus was assessed.
Results. The received data on caries intensity in all age groups and all medical conditions were analyzed. The values corresponded to the high and very high intensity (4.2 to 13); the values were 1.89 – 3 times higher than the values received during the epidemiological survey in children of the same age groups in Russia. Multiple primary and secondary (as a complication after the previous dental treatment) caries, associated with poor oral hygiene, was detected. The data revealed that the dental care level in children with rheumatic diseases was ‘poor’ and ‘insufficient’ The interview of the children and their parents showed that 91% of children had never had preventive treatment and 89% of children visited the dentist less than twice a year. The examination revealed that secondary caries, that had developed in 50% of children after the treatment of caries and its complications, and bad fillings, that had to be replaced.
Conclusions. Thus, indirect influence of the main disease on the hard dental tissues in children was revealed – motivation for dental treatment and good oral hygiene was decreased for the lack of knowledge. The analysis of dental treatment quality in such children was insufficient. Only emergency dental visits as well as inappropriate materials and methods used for the treatment of caries and its complications result in secondary caries. So, customized treatment approach and prevention programs should be developed and introduced for the oral care in children with rheumatic diseases according to the main disease course, administered background therapy and the level of dental health education.

Relevance. Autism spectrum disorder (ASD) is a developmental disorder, showing up in children under 3 years old and characterized by the triad of symptoms (qualitative impairment of social interaction and communication, stereotype behavior and non-specific problems) and the dyad of impairment in social interaction, restricted and repetitive patterns of behavior and/ or interests. According to the Russian and international literature, the prevalence of ASD has tended to grow in the 21th century. Children with ASD experience difficulties in communication and manual skills. The oral hygiene in children with ASD is poor, they need their parents’ help brushing their teeth as well as preparing for a dental visit. Thus, improvement of communication techniques is an urgent challenge for these children.
Materials and methods. 75 parents of children with ASD aged 4 to 16 years were surveyed.
Results. The received results demonstrated that the parents of children with ASD have very little knowledge about the oral hygiene. While preparing for a dental visit the majority of parents do not use communication techniques, which leads to doctor-patient interaction difficulties.
Conclusions. The received data showed that techniques for applied behavior analysis, alternative communication system prove to be highly effective in preparing children with ASD for a dental visit, thus, increasing the effectiveness of preventive procedures.

Relevance. The correct choice of the surgical technique for the treatment of the congenital asymmetric cleft lip and palate ensures the effectiveness of rehabilitation of patients with this pathology. The purpose is to present the results of the authors’ techniques for the surgical treatment of children with asymmetric cleft lip and/or palate.
Materials and methods. Medical records of 687 children treated in 2015-2019 years were retrospectively analyzed at the clinic of maxillofacial surgery “Bonum” MСMC. The prevalence of asymmetric cleft lip and palate in children was determined. The prospective observation group included 84 patients with asymmetric cleft lip and/or palate. Clinical, anthropometric, statistical methods as well as patient photograph analysis and computer technologies were used during the research.
Results. Prevalence of congenital asymmetric cleft lip and / or palate was determined (8.59%), classification and novel surgical techniques were offered and the results were evaluated.
Conclusions. The prevalence of asymmetric cleft lip and palate is 86 per 1000 newborns with cleft lip and/ or palate. Scientific knowledge about the prevalence of asymmetric cleft lip and palate, as well as the systematization of this type of lesion in classifications, should be present in the practice of a maxillofacial surgeons and rehabilitation physicians who treat patients with this pathology. The proposed surgical techniques for the treatment of asymmetry in bilateral cleftlip and cleft palate provide positive results, excluding the need for further surgery. The reasonable choice of a surgical technique for the treatment of asymmetric cleft lip and palate is individual and may involve the use of additional nanomaterials. The authors’ techniques for the surgical treatment of asymmetric cleft lip and palate can be considered promising and aesthetically justified in view of good cosmetic results and full restoration of functions.

Relevance. Various factors can cause facial neuropathy. Iatrogenic facial nerve injury in childhood and adolescence is a complicated medical, psychological and legal problem. Risk assessment of the facial nerve injury during the elective maxillofacial surgeries is required depending on the localization of the procedure. The statistical assessment is very important for the evaluation of the possible iatrogenic facial neuropathy in children and adolescents during the elective maxillofacial surgeries.
Materials and methods. 715 medical records for 2017 from the Department of Pediatric Maxillofacial Surgery of the MSUMD Clinical Center for Maxillofacial, Reconstructive and Plastic Surgery were analyzed.
Results. There was a risk of injury to the trunk or branches of the facial nerve during surgery in 121 cases (16,9%) for the technical complexity of the surgical approach and the pathology location.
Conclusions. There is a high risk of the facial nerve injury during the elective maxillofacial surgery in children and adolescents due to the complex anatomy of the area. Intraoperative neuromonitoring is recommended to prevent iatrogenic neuropathy of the facial nerve.

Relevance. Effective pain relief is required for high-quality outpatient dental treatment in children. Infiltration and PDL local anesthetic injection techniques are easier and safer for young patients. Purpose – to determine the effectiveness and safety of the modified PDL anesthetic injection technique in the pediatric dental practice.
Materials and methods. The study involved 100 children aged 4 to 7 years, in need of caries and pulpitis treatment in the primary dentition. 4% articaine solutions with 1: 200000 and 1: 400000 epinephrine were administered as a local anesthetic. The effectiveness of the treatment was determined by the visual analogue scale.
Results. The study determined the high effectiveness and safety of the modified technique of PDL anesthetic injection of 4% articaine solution with epinephrine ratio 1:200 000 and 1:400 000 for the treatment of caries and pulpitis in 100 children aged 4-7 years.
Conclusions. The conducted studies have demonstrated the high ffectiveness and safety of the modified PDL anesthetic injection technique of a 4% solution of articaine with epinephrine both at a concentration of 1:200 000 and 1:400 000.

Relevance. The high prevalence and intensity of early childhood caries (ECC) require a detailed analysis of the influence of the nutritional status on the course of the carious process and possible ways to treat severe caries and control certain markers of calcium and phosphorus metabolism. Purpose – to identify correlation between the nutrient composition of the diet, calcium and phosphorus metabolism markers and severe childhood caries.
Materials and methods. The study involved 46 children aged 12-36 months with severe ECC which had been treated under the general anesthesia. In all patients, the nutrient composition of the diet was studied and certain markers of calcium and phosphorus metabolism were determined. ECC comprehensive treatment plan with further evaluation of the effectiveness of the treatment was developed accordingly, based on the patients’ allocation to the main and comparison groups.
Results. The dynamics of the content of excreted calcium in the main group of study participants indicates an increase in the consumed calcium entering the child's body with food. 24 months after the implementation of pathogenetic therapy, the increase in the intensity of caries in the main group was significantly reduced.
Conclusions. The correlation analysis revealed a strong correlation between the frequency of consumption of the basic food products and caries intensity in the primary teeth. Patient-based ECC treatment protocols can reduce caries progression in primary dentition by 42.8 % in the long run.

Relevance. The article studies the primary canine premature extraction as the cause of three-dimensional (sagittal, transversal, vertical) bone underdevelopment in the area of the extracted tooth. The research is relevant as there are insufficient data in the scientific literature on this topic and the prevalence of premature primary canine extraction for therapeutic and orthodontic indications is high.
Materials and methods. The present case study developed a special technique for bone volume measurement in all planes by CBCT.
Results. Several CBCTs of one patient over the period of three years were analyzed according to the suggested technique. The calculations demonstrated significant sagittal and vertical bone loss.
Conclusions. The results of the research allowed us to conclude that premature extraction of the primary canines leads to the significant sagittal and vertical bone loss. Besides, no increase in the intercanine distance was detected despite the patient’s growth spurt.

Relevance. The high necessity in orthodontic treatment among young patients and the use of fixed orthodontic appliances for the treatment of dental pathology are the factors that initiate inflammatory periodontal processes. Timely diagnosis and optimal preventive and treatment procedures can prevent or stop the inflammatory periodontal complications which could have developed during the orthodontic treatment. One of the effective methods for the prevention and treatment of inflammatory periodontal diseases is the use of targeted antimicrobial agents based on medicinal plants that have specific antimicrobial activity against periodontal pathogens. Purpose – to study the effectiveness of the dental gel with barberry extract for the treatment of plaque-induced gingivitis in orthodontic patients during the active phase of the treatment with fixed appliances.
Materials and methods. The study included 60 patients (35 women and 25 men) aged 18 to 35 years who had presented for the orthodontic care. The patients undergoing orthodontic treatment with fixed appliances were randomly divided into two groups. In group I, the patients were prescribed applications of a dental gel with barberry extract; in group II, this medication was not prescribed. The clinical condition of the periodontium was assessed with periodontal indices PMA, SBI and OHI-S. The immune status was evaluated by the level of secretory IgA, interleukins (IL-1β and IL-4) and tumor necrosis factor-α (TNF-α). The patients were followed up during 1 month of treatment. The results were statistically processed with Statsoft Statistica 8.0 and Graph Pad Prism 5.0.
Results. In group II, the production of immunoglobulin IgA, pro- and anti-inflammatory cytokines was impaired after a month of treatment, associated with a significant deterioration in the oral hygiene status and an increase in PMA (by 3 times), SBI (by 5.3 times) indices. In group II, the oral fluid concentrations of IL-1β, IL-4 and TNF-α significantly differed from those in group I as of the 7th day of the observation period and indicated suppression of the mucosal immunity. Clinical and immune parameters of the group I patients improved and were comparable with the control by the end of the observation month.
Conclusions. Patients with dental abnormalities are at risk of developing inflammatory periodontal diseases. The results of the immunological tests, performed during the treatment with the use of a dental gel with barberry extract, demonstrated the recovery of the local immunity, as evidenced by the elevation of secretory immunoglobulin A in saliva and improvement of cytokine profile parameters.

Relevance. Skeletal Class III malocclusion is known to be one of the most difficult malocclusions to correct. Nonsurgical treatment of Class III in adults is a challenge; however, this patient refused surgery. A treatment method with Fixed Anterior Growth Guidance Appliance (FAGGA) was investigated in the study.
Materials and methods. This case report presents a 37-year-old woman with skeletal Class III malocclusion for maxillary deficiency. As the patient didn’t agree to surgery, she was treated by Fixed Anterior Growth Guidance Appliance, followed by 3D SMILE® clear aligners. Fixed Anterior Growth Guidance Appliance was used initially. After 4 months, the appliance was removed and clear aligner treatment was initiated. Post-treatment radiographs showed improvement.
Results. Intraorally, in the upper arch, a total of 4.00 mm of space were gained (about 2.00mm distal to each canine). The post-treatment cephalometric analysis showed a skeletal A-P Class I, the Upper incisor inclination to the optic plane was not significantly altered, ANS — antArc was improved by 1.5mm, the Effective Length of the Premaxilla increased by 2.6mm, U1 — ANS’ decreased by 1.7mm, Incisor mandibular plane angle (IMPA) autonomously improved by 11 degrees.
Conclusions. Maxillary deficiency was corrected successfully with the Fixed Anterior Growth Guidance Appliance. The treatment is being continued by 3D SMILE® clear aligners. The goal was achieved despite the patient’s age and nonsurgical treatment.

Relevance. The article presents an analysis of the key dental problems during the pandemic of the novel coronavirus infection (COVID-19), discussed on the platform of the interdisciplinary all-Russian online conference „Prevention of cross-infection at dental appointments in the context of the COVID-19 pandemic”. The high professional interest of dentists in the problems of high risk of transmission of infection at a dental appointment, the role of dental manifestations in the general symptom complex of COVID-19, the possibilities of testing saliva for SARS-CoV-2, the peculiarities of providing specific types of dental care in different periods of a pandemic, dental (hygienic) accompanying patients in outpatient and inpatient treatment, including in intensive care units. Based on the analysis of existing data on the immunopathogenesis of the disease, the main risk factors and routes of infection, the principles of systematization of COVID-associated diseases (conditions) of the oral cavity, the proposed approaches to their correction and treatment were discussed. Based on the results of our own observations and analysis of foreign publications, clinical variants of the manifestation of the disease (or its medication support) in the oral cavity have been analyzed. The important role of interdisciplinary approaches (dentists, healthcare organizers, epidemiologists, microbiologists, immunologists, etc.) to solving dental problems during a pandemic is emphasized. The role of modern IT-technologies, telemedicine and teledentistry in the implementation of educational and scientific-practical activities for the medical and dental community during a pandemic is highlighted.

Relevance. Lymphatic and venolymphatic malformations account for 6-18% of benign lesions in children. In most cases, the head and neck regions are affected, with 50% of intraoral lesions occurring in the tongue. Venolymphatic malformation of the tongue leads to severe functional problems, even life-threatening, to serious esthetic defects and social maladjustment. Diagnosis and treatment of this patient population is a difficult and unsolved problem in pediatric maxillofacial surgery since there is no common algorithm for managing such patients. Purpose – optimization and improvement of the rehabilitation’s effectiveness of children with lymphatic and venolymphatic malformations of the tongue by creating a clear algorithm for the diagnosis and treatment of this patients’ group.
Materials and methods. A child aged 1 year and 5 months was treated for venolymphatic malformation of the tongue, macroglossia. In addition to general clinical examination methods, the mandatory diagnostic methods were ultrasonography of pathological tissues, MRI (magnetic resonance imaging) and CT (computed tomography) of the head and neck with intravenous administration of a contrast agent, fibrolaryngoscopy. The child was operated on in two stages: the first stage was a refined resection of the tongue followed by its plastic surgery with the local tissues, the second stage was the removal of the superficial malformation of the tongue using a semiconductor laser LSPIRE-Polyus (ЛСП-«ИРЭ-Полюс»). The surgery was performed under the general anaesthesia. A histopathological examination of the specimen was performed to clarify the diagnosis.
Results. The outcome of the treatment was good: functional and esthetic problems were solved, the child became socially adapted. There were no complications during the intra- and postoperative periods. The method of removing the superficial form of venolymphatic malformation of the tongue using a semiconductor laser has once again demonstrated its effectiveness (patent for invention No. 2676832).
Conclusions. When examining such children, it is necessary to adhere to a specific diagnostic plan. The treatment of this patients’ group is interdisciplinary and comprehensive, with the obligatory adherence to a clear treatment algorithm, which allows achieving good functional and esthetic outcome. The advantages of laser treatment of the superficial form of venolymphatic malformation of the tongue are the reduction in the risk of recurrence due to the complete and immediate removal of pathological tissues; decrease of the invasiveness of the operation for the precise action of the laser radiation, as well as the simultaneous coagulating effect of laser radiation; improving the functional and esthetic outcome of treatment; reducing the cost of treatment for this group of patients by decreasing the period of the hospital stay.