Purpose: Based on the excellent long-term data, dental implants made of titanium are considered the international implantological standard for replacing missing teeth. However, ceramic implants made of zirconia (ZrO₂) have experienced a renaissance in the last 15 years due to constant innovations in materials and products, with material properties and soft tissue- and osseointegration behavior comparable to those of titanium. However, one limitation concerning ceramic implants is the lack of reliable long-term data, especially in the case of two-piece implant systems. As there is an increasing demand for ceramic implants from practitioners and patients, the German Society for Implantology (DGI) has decided to develop a guideline on the use of dental ceramic implants at the highest available evidence level with the involvement of experts in this field. Methods: Statements and recommendations were prepared after conducting a systematic literature search and an independent assessment process involving the relevant clinical literature from 2008 to 2021. The adopted recommendations and statements are summarized in this guideline. Results and conclusions: It confirms the feasible use of one-piece zirconia implants as an addendum/alternative to titanium implants. No final conclusion regarding the application of two-piece ceramic implant systems could be drawn on the basis of the existing data, thus its use can only be recommended after the patient has been informed in detail about the lack of long-term clinical data.

Objective: Pain management is a significant challenge in dental care, making analgesics the most commonly prescribed drugs by dentists. Since many analgesics are available over the counter, data on their use in dental practice is imprecise. This study aimed to gather information on the prescription and recommendation patterns for systemic analgesics among dental practitioners. Materials and methods: A total of 1,746 dentists were contacted via email and letter and invited to participate in an online survey. The survey covered four sections: personal data, acute and chronic pain management, preemptive analgesia, and managing at-risk patients. Results: 232 dentists participated in the survey. Ibuprofen, typically at 600 mg, was the most commonly recommended analgesic for both acute and chronic pain. For acute pain, analgesics were prescribed for 1–3 days on average. Two-thirds of respondents did not use preemptive analgesia, and of those who did, 96.56% recommended ibuprofen. Notably, in 22.16% of cases, contraindicated analgesics were recommended for patients with renal, liver, or cardiovascular conditions. Conclusions: The analgesics recommended by dentists are limited in variety and often do not align with specific clinical indications. Nonsteroidal anti-inflammatory drugs, especially ibuprofen, are commonly used long-term, despite conflicting recommendations. A significant number of dentists prescribed contraindicated medications to at-risk patients. Only one-third utilized preemptive analgesia, underscoring the need for improved education and greater use of this approach in dental practice. Clinical relevance: There is a clear need for enhanced training on analgesic use and preemptive analgesia to improve patient safety, particularly for those with risk factors. Graphical

Free flap tissue transfer represents the gold standard for extensive defect reconstruction, although malperfusion due to thrombosis remains the leading risk factor for flap failure. Recent studies indicate an increased immune response and platelet activation in connection with pathologic coagulation. The underlying cellular and molecular mechanisms remain poorly understood, however. The presented study, therefore, aims to investigate if transfer-related ischemia alters intra-flap metabolism and electrolyte concentrations compared to central venous blood after free flap transfer in pigs to establish a novel experimental model. Free transfer of a myocutaneous gracilis flap to the axillary region was conducted in five juvenile male pigs. The flap artery was anastomosed to the axillary artery, and intra-flap venous blood was drained and transfused using a rubber-elastic fixed intravenous catheter. Blood gas analysis was performed to assess the effect of transfer time-induced ischemia on intra-flap electrolyte levels, acid–base balance, and hemoglobin concentrations compared to central venous blood. Time to flap reperfusion was 52 ± 10 min on average, resulting in a continuous pH drop (acidosis) in the flaps’ venous blood compared to the central venous system (p = 0.037). Potassium (p = 0.016), sodium (p = 0.003), and chloride (p = 0.007) concentrations were significantly increased, whereas bicarbonate (p = 0.016) and calcium (p = 0.008) significantly decreased within the flap. These observations demonstrate the induction of anaerobic glycolysis and electrolyte displacement resulting in acidosis and hence significant tissue damage already after a short ischemic period, thereby validating the novel animal model for investigating intra-flap metabolism and offering opportunities for exploring various (immuno-) thrombo-hemostatic issues in transplantation surgery.