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1.
Cureus ; 16(6): e61883, 2024 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-38975401

RESUMO

A C-shaped canal describes an anatomical configuration of a tooth's root canal that resembles the alphabet C when viewed occlusally in a prepared access cavity. In the second molar of the maxillary arch, the root canals unite into a single, continuous, extensive root canal morphology to form a C-shaped canal. The natural crevices found in tooth roots where blood vessels and nerves are housed are called root canals. The frequently referred etiology resulting in the development of the C-shaped canal arrangement is the inability of Hertwig's epithelial root sheath to undergo fusion. The occurrence of the C-shaped canal anatomic variation varies among populations, with the majority of cases occurring in mandibular second molars. C-shaped canals pose several challenges in endodontic treatment such as in their diagnosis, biomechanical preparation, debridement, and obturation. Nevertheless, the desired result can be achieved with relative ease if one has a solid grasp of the different root canal configurations and uses the relevant clinical expertise. Therefore, three-dimensional radiography is utilized to help identify and negotiate C-shaped canals by enabling three-dimensional reconstruction of the root canal system. Efficient C-shaped canal configuration treatment may be attained using hand-driven and rotary instruments assisted by sonic or ultrasonic hand-pieces. Four alternative gutta-percha filling methods are used in C-shaped canals: core-carrier, ultrasonic compaction, cold lateral compaction, and single cone with injectable gutta-percha. The core-carrier technique is the most efficient obturation technique in the C-shaped canal. Calcium silicate materials (CSMs) are also used for the obturation of C-shaped canals. The most frequently used CSMs are mineral trioxide aggregate and biodentine.

2.
Cureus ; 16(5): e61108, 2024 May.
Artigo em Inglês | MEDLINE | ID: mdl-38919245

RESUMO

Some conditions known as temporomandibular disorders (TMDs) affect surrounding muscles and jaw joints. In dentistry, there has been discussion and research on the connection between TMDs and occlusion, which is how the upper and lower teeth meet. Although some dental experts have proposed a direct link between TMDs and occlusion, the specifics of this relationship are still unclear and have many facets. More particularly, the research facets of "occlusion" remain one of the most contentious subjects in TMDs. This abstract aims to provide an overview of TMDs and occlusion, summarizing the key points from the literature. The etiological factors contributing to the TMDs, including occlusal, psychological, and hormonal factors, are also analyzed. The second part of the article includes the concept of malocclusion, emphasizing its significance in masticatory function and overall health. Anterior open and posterior open bites and the potential influence of occlusal factors on TMDs are elucidated.

3.
Cureus ; 16(5): e60269, 2024 May.
Artigo em Inglês | MEDLINE | ID: mdl-38872665

RESUMO

A radicular cyst is characterized as an odontogenic cyst of inflammatory origin that develops from Malassez epithelial rests in the periodontal ligament as the consequence of dental pulp inflammation. The cyst commenced in the carious tooth and spread to the periodontal and periapical regions. The majority of these lesions appear as precise radiolucencies and encompass their entire apex. The cystic lesion, which is also called a root-end cyst or periapical cyst, is sometimes referred to as a true cyst because it is lined by fluid epithelium. There are several treatment options to address radicular cysts, including surgical and nonsurgical methods. In this case study, we described the clinical observation of the cyst. The cyst typically manifests in later life due to its prolonged etiology. The maxillary anterior region is the most frequently utilized site.

4.
Cureus ; 16(5): e61182, 2024 May.
Artigo em Inglês | MEDLINE | ID: mdl-38933609

RESUMO

A smooth, red, oval, or rhomboid patch on the dorsal midline is the classic presentation of median rhomboid glossitis (MRG), a rare and benign lesion of the tongue. MRG is still not fully understood, which presents diagnostic hurdles and calls for additional clinical investigation. It is frequently associated with candidal infections. We describe a case of a 42-year-old man who initially appeared to have either mechanical irritation or thermal injury related to a painless patch on the dorsum surface of the tongue. We document a case of MRG that was consulted for a standard dental examination in this case report. This article also highlights a dentist's need to identify the lesion and provide appropriate education for the patient.

5.
Cureus ; 16(4): e59216, 2024 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-38807828

RESUMO

Radicular cysts are the most common forms of cysts in the jaws. They develop from epithelial residues in the periodontal ligament in response to periapical infection following pulpal necrosis. This condition is typically asymptomatic and mostly affects the tooth's apices. It primarily affects non-vital teeth and is characterized by inflammation. Cyst development is the final stage of the inflammatory process after a periapical infection; hence, it often occurs later in life. A cyst in the maxilla can occasionally spread across the maxillary sinus. Radicular cysts can be treated with surgical endodontics, the removal of the problematic tooth, enucleation with primary closure, or marsupialization and enucleation. This case report discusses a successful surgical therapy for an infected radicular cyst.

6.
Cureus ; 16(3): e55522, 2024 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-38576654

RESUMO

The frenum is a mucous membrane fold that connects the lip and cheek to the gingiva, periosteum, and alveolar mucosa. When the frena are linked too closely to the gingival border, there may be issues with plaque removal, and the overall gingiva may be affected. In addition, the maxillary frenum may provide aesthetic difficulties or interfere with the aesthetic outcome in cases of midline diastema, which may result in a recurrence after treatment. A labial frenectomy, a frequently performed surgical operation in the specialty of dentistry, is used to address such an abnormal frenum. This article describes a case study of a maxillary labial frenectomy using a traditional scalpel approach and topical application of ozonated olive oil.

7.
Cureus ; 16(2): e54115, 2024 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-38487109

RESUMO

Periodontal disease, characterized by inflammation and infection of the supporting structures of teeth, presents a significant challenge in dentistry and public health. Current treatment modalities, while effective to some extent, have limitations in achieving comprehensive periodontal tissue regeneration. This comprehensive review explores the potential of stem cell therapy in advancing the field of periodontal regeneration. Stem cells, including mesenchymal stem cells (MSCs) and induced pluripotent stem cells (iPSCs), hold promise due to their immunomodulatory effects, differentiation potential into periodontal tissues, and paracrine actions. Preclinical studies using various animal models have revealed encouraging outcomes, though standardization and long-term assessment remain challenges. Clinical trials and case studies demonstrate the safety and efficacy of stem cell therapy in real-world applications, especially in personalized regenerative medicine. Patient selection criteria, ethical considerations, and standardized treatment protocols are vital for successful clinical implementation. Stem cell therapy is poised to revolutionize periodontal regeneration, offering more effective, patient-tailored treatments while addressing the systemic health implications of periodontal disease. This transformative approach holds the potential to significantly impact clinical practice and improve the overall well-being of individuals affected by this prevalent oral health concern. Responsible regulatory compliance and a focus on ethical considerations will be essential as stem cell therapy evolves in periodontal regeneration.

8.
J Family Med Prim Care ; 13(1): 157-162, 2024 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-38482332

RESUMO

Background: The present study was carried out to assess the awareness of the adverse consequences of tobacco use in the semi-urban school population in Wardha district because tobacco use in schools is a significant concern and is rising at an alarming rate. The purpose of the current study was to assess the prevalence of tobacco use among students and teachers as well as their knowledge of the negative effects of tobacco use. It also aimed to educate students and teachers about these effects and assess the effectiveness of the intervention. Methodology: A total of 350 students from a semi-urban school in the Wardha area participated in this study. Pre-tests were administered to a group of chosen kids and instructors to gauge their familiarity with tobacco. After the pre-test data were analyzed, teachers were offered intervention. PowerPoint presentations, posters, and models were used to educate them about the dangers of tobacco usage for dental health. There were discussions, role plays, and skits done. After the instruction, the students took a post-test to gauge how well they understood what they had learned. Results: The recent study is a significant step toward the semi-urban school population quitting smoking. Overall, the study involves testing participants' knowledge, teaching them about tobacco's negative consequences, and inspiring habitual smokers to completely kick the habit. The majority of the NTCP questionnaire's elements were significant when compared to knowledge of tobacco use and its components (*p0.05; significant). Conclusion: The suggested study is a significant step toward the semi-urban school population quitting smoking. The research will provide a genuine and dependable change and help promote optimal dental health.

9.
Cureus ; 16(1): e51684, 2024 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-38318575

RESUMO

Till now, oral squamous cell carcinoma (OSCC) is graded as well-differentiated, moderately-differentiated, poorly-differentiated, and undifferentiated. However, this grading does not have a prediction of the prognosis of the patient. Also, prognosis impacts lymph node metastases, surgical margins, and vascular invasions (neural invasion, muscular invasion, salivary gland invasion). The prognosis of lymph node metastases is significant, which affects the survival of the patients which is 50%. So, a dependable blood marker is needed for prognosis in OSCC patients with loco-regional and distant recurrence. Some factors can be assisted only after surgery and invasive techniques to check the prognosis of the disease. Despite the ease of examining the oral cavity, there is no practical approach for non-invasive screening and detecting cancer. As it is abrupt to use such invasive procedures from time to time, there is a need for nonsurgical and reliable techniques to assess the progression of tumors. Also, frozen sections are helpful during the intraoperative procedure to evaluate the lymph node metastases. An increase in the number of tumor cells through blood is a significant event in disease metastases toward the peripheral blood. Oral health impact assessment instruments could aid in determining the quality of life, and their usage in the initial stages of oral carcinoma could help physicians choose the best treatment option for enhancing the quality of life.

10.
Cureus ; 15(11): e48593, 2023 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-38090434

RESUMO

The nanosciences have recently emerged as a transformative force in dentistry and periodontics, offering fresh strategies to further the development of dental care. This paper provides a concise summary of the effect of nanoparticles, their categorisation, several methods of action, and various dental uses. This review discusses the properties of nanoparticles that lend to their use in dentistry and traces the history of the growth and advancement of nanotechnology in this area, nanomaterials' role in improving dental restorations' durability, aesthetics, and overall dental health by drawing on particular examples from restorative dentistry, prosthodontics, cosmetic dentistry, and general dentistry. In addition, the advancement of nanosciences has made periodontal regeneration easier, which has resulted in more accurate forecasting of its effects. Issues relating to safety, finances, and regulations imposed by the government have been fixed. It is encouraged that research be conducted into the full potential of nanosciences in dentistry and periodontics as a method of realising the field's bright future. Applications of nanotechnology in dentistry and periodontics can be broadly discussed under the prevention, detection, and treatment modalities.

11.
Cureus ; 15(11): e48308, 2023 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-38058347

RESUMO

The dentistry specialty known as periodontology focuses on problems with the tissues that support and surround teeth. A thorough understanding of basic sciences and health care is necessary for periodontology. To ensure that the dentition has adequate form, function, esthetics, and comfort, it is essential to have a thorough understanding of the relationship between periodontal tissues and how it relates to other branches of dentistry, such as restorative dentistry, orthodontics, prosthodontics, and implants. The periodontal ligament is a soft tissue between the alveolar bone and teeth. Since the alveolar bone is the foundation for successful dental treatment, proceeding with subsequent dental procedures, including restorative dentistry, implants, and prosthetic uses, is only possible with sufficient bone support. The current review article aims to assess the perception of undergraduate students regarding periodontics and its range of practice. It also gives a general overview of the field of periodontology by outlining current practices, exploring how students perceive this branch's range of courses, and emphasizing more recent and sophisticated developments.

12.
Cureus ; 15(11): e48242, 2023 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-38054128

RESUMO

Maxillofacial reconstructive implants are typically created in standard shapes and have a widespread application in head and neck surgery. During surgical procedures, the implant must be correctly bent according to the architecture of the particular bones. Bending takes practice, especially for untrained surgeons. Furthermore, repeated bending may increase internal stress, resulting in fatigue in vivo under masticatory loading and an array of consequences, including implant failure. There is a risk of fracture, screw loosening, and bone resorption. Resorption, infection, and displacement are usually associated with the use of premade alloplastic implants and autogenous grafts. Recent technological breakthroughs have led to the use of patient-specific implants (PSIs) developed by computer-designed additive manufacturing in reconstructive surgery. The use of computer-designed three-dimensional (3D)-printed PSI allows for more precise restoration of maxillofacial deformities, avoiding the common difficulties associated with premade implants and increasing patient satisfaction. Additive manufacturing is something that refers to a group of additive manufacturing methods. This technique has been quickly used in a variety of surgical procedures. The exponential expansion of this technology can be attributed to its enormous surgical value. Adding 3D printing to a medical practice can be a rewarding experience with stunning results.

13.
Cureus ; 15(11): e48218, 2023 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-38054133

RESUMO

Pulpectomy has always been a treatment choice when irreversible damage to the pulpal and periapical tissues occurs, but in a pediatric patient, expecting cooperation and adequate chair side time is a huge task as they fear the dentists and the instruments. Hence, it was required that there come an advanced treatment protocol that helps overcome the drawbacks of the existing treatment modality. A new therapeutic strategy called lesion sterilization and tissue repair (LSTR) is revolutionizing how dental lesions are treated today. Through a non-invasive antimicrobial treatment, this cutting-edge method seeks to halt the spread of carious lesions while encouraging tissue repair and regeneration. In LSTR, the infected tooth tissues are treated directly with a special antimicrobial combination of antibiotics, reducing agents, and disinfectants. Through the elimination of the microorganisms that cause dental decay and the creation of an environment that is favorable for natural tissue healing, this intervention targets the microbial etiology. This article mainly focuses on using antibiotics as a treatment modality in a tooth affected by caries and where the pulp and periradicular tissues are irreversibly inflamed. Pulpectomy has always been the most practiced technique, but in children, due to the lack of cooperation during the treatment and harm to the underlying developing tooth bud, a less invasive protocol had to be used, which is LSTR. This review delves into the basic ideas, techniques, and clinical applications of lesion sterilization and tissue restoration to look at its various aspects. This review clarifies the effectiveness and safety of LSTR in controlling diverse dental diseases, ranging from early-stage caries to deep dentin infections, by critically assessing previous study findings. It also emphasizes LSTR's ability to preserve vital tooth pulp, obviating the need for invasive and frequently uncomfortable endodontic operations. The review advocates for integrating LSTR into contemporary dental practices, showcasing its potential to transform the landscape of oral healthcare. By providing a comprehensive overview of this innovative technique, this review encourages further research and clinical implementation, heralding a new era in dentistry focused on preservation, regeneration, and enhanced patient well-being.

14.
Cureus ; 15(11): e49319, 2023 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-38143639

RESUMO

The integration of artificial intelligence (AI) into dental care holds the promise of revolutionizing the field by enhancing the accuracy of dental diagnosis and treatment. This paper explores the impact of AI in dental care, with a focus on its applications in diagnosis, treatment planning, and patient engagement. AI-driven dental imaging and radiography, computer-aided detection and diagnosis of dental conditions, and early disease detection and prevention are discussed in detail. Moreover, the paper delves into how AI assists in personalized treatment planning and provides predictive analytics for dental care. Ethical and privacy considerations, including data security, fairness, and regulatory aspects, are addressed, highlighting the need for a responsible and transparent approach to AI implementation. Finally, the paper underscores the potential for a collaborative partnership between AI and dental professionals to offer the best possible care to patients, making dental care more efficient, patient-centric, and effective. The advent of AI in dentistry presents a remarkable opportunity to improve oral health outcomes, benefiting both patients and the healthcare community.

15.
J Educ Health Promot ; 12: 343, 2023.
Artigo em Inglês | MEDLINE | ID: mdl-38144021

RESUMO

Studies on Sturge-Weber syndrome (SWS) have already focused on various medical aspects of this syndrome. This review is focusing on the psychological aspects of Sturge-Weber syndrome patients, the behaviors of patients, and the effects of the disease on the children. This disorder is characterized by angiomas, glaucoma, and seizures with a birthmark. Patients with this syndrome have behavioral problems, a lack of social skills, and a lack of intellectual or academic skills. These patients are usually introverted because of a lack of warmth and limited communication. Friends or classmates tease them by calling them "ugly." All this leads to a lack of social skills, and they mostly keep their feelings to themselves and prefer to be alone. Because of all this mocking by classmates, they keep isolating themselves. All this causes psychological problems in children. They start behaving differently, have suicidal tendencies, and fight with their friends who bully them. Psychological problems are mostly seen in children who are lacking in intelligence and functioning and who have seizure disorders, mostly in those who have frequent seizures. Problems like anxiety, depression, mood changes, anger, and violence are also observed in these patients. All this is always ignored by the parents as well as the doctors. This review aims to focus on the psychological aspect of the patients with SWS, to inform the parents about the behavior of their children with SWS, and to pay more attention to the psychological problems. This review is focusing on the importance of the psychological behavior of patients with SWS, how to diagnose it at an early stage, and how to treat and take care of children with SWS.

16.
Cureus ; 15(11): e49399, 2023 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-38146583

RESUMO

This review delves into the intricate interplay between osteoporosis, its treatment approaches, and oral health. The examination underscores the substantial impact of osteoporosis, characterized by reduced bone density, on various oral health parameters such as periodontal health, tooth loss, and jawbone density. While pharmacological interventions, including bisphosphonates and hormone replacement therapy, play a crucial role in managing osteoporosis, they necessitate careful consideration, particularly about the risk of osteonecrosis of the jaw. A comprehensive approach involving collaboration between dentists and healthcare providers is imperative for holistic patient care. Implementing screening protocols for osteoporosis in dental settings and meticulously planning dental procedures for patients undergoing osteoporosis treatments are vital aspects of clinical practice. This review also sheds light on emerging trends in osteoporosis research, such as the influence of genetic factors and the microbiome, emphasizing the necessity for innovative treatment modalities. In conclusion, the review provides valuable insights into the nuanced connections between osteoporosis and oral health, thereby laying a foundation for informed clinical practices and guiding future research initiatives. Furthermore, it highlights the importance of optimizing dental procedures and assessing long-term oral health outcomes as critical avenues for future research endeavors.

17.
Cureus ; 15(11): e49437, 2023 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-38149156

RESUMO

The relentless march of technological progress entails constant evolution and adaptation. A concerted effort is underway in medical research to unravel various diseases' cellular and molecular underpinnings. The traditional approaches to disease treatment often fall short of delivering entirely satisfactory outcomes, which has prompted a shifting spotlight on gene therapy as a versatile solution for many inherited and acquired disorders. Genes, intricate sequences of genetic code, are the complicated blueprints dictating the production of essential proteins within the human body. Remarkably, each individual's genetic makeup is uniquely distinct, with variations in these genetic sequences serving as the bedrock of our diversity. Gene therapy represents an innovative medical strategy that harnesses the power of genes themselves to function as therapeutic agents. It serves as a conduit through which defective genes are either substituted or mended with the introduction of remedial genetic material. This groundbreaking method can tackle various illnesses, from conditions originating from single-gene abnormalities to intricate disorders influenced by multiple genes. In dentistry and periodontics, gene therapy finds a promising array of applications. It contributes significantly to managing salivary gland disorders, autoimmune diseases, and the regeneration of damaged bone tissue, as well as addressing cancerous and precancerous conditions. Moreover, the possibilities extend into DNA vaccination and broader areas of oral health. The advent of gene therapy in dentistry represents a new era of significant progress, offering substantial advancements in the management of periodontal disease and the reconstruction of the dental alveolar apparatus. The aim of this narrative review is to provide a comprehensive overview of the landscape of gene therapy investigations in these disciplines, shedding light on its potential implications for oral health and treatment. With its potential to rectify the genetic underpinnings of various conditions, gene therapy offers a novel frontier in healthcare that continually shapes the landscape of medicine and holds the promise of more effective and personalised treatments.

18.
Cureus ; 15(10): e46443, 2023 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-37927733

RESUMO

Background  Latex gloves are used more frequently by dental, medical, and other health workers and their allergy has also increased as a result, dentists are frequently exposed to latex or nitrile gloves for extended periods. This prolonged exposure often leads to local symptoms such as itching and erythema rashes. However, some dentists experience more severe systemic reactions, including swelling, wheezing, breathlessness, and even an increase in blood pressure. Latex gloves have recently been replaced with nitrile gloves, powder-free latex gloves, and other preventive measures to avoid allergies. Latex allergies are more common than nitrile allergies, as they are hypoallergic with properties such as tear-resistant and provide an equivalent level of defense against various dental materials and procedures. Women experience more allergic reactions than men. Not only are dentists exposed to this allergy but the patient can also be exposed during the procedure. This study aimed to assess hypersensitive reactions to the use of latex and nitrile gloves among general dentist practitioners and dental students. Methods A cross-sectional study was conducted in Wardha, Maharashtra, India, to evaluate allergic reactions to latex and nitrile gloves among general dental practitioners and dental students at college. A questionnaire-based study was conducted with a sample size of 356. The self-administered survey inquiries about glove compliance, the time they wear the gloves, regular glove use, and problems related to latex or nitrile contact. In addition, dentists and dental students' personal histories of allergies to medications, dental materials, disinfectants, or other chemicals were noted, as well as signs and symptoms they experienced from prolonged contact with gloves. Result The total number of responses collected was 356. The investigated dentists were 274 and 82 were students, out of which 122 (34.3%) were male and 234 (65.7%) were female. Responses showed that 224 (62.92%) used latex gloves, and 132 (37.08%) used nitrile gloves. Among 356 participants 175 showed symptoms by the use of both latex and nitrile gloves, out of which 85.14% showed allergy to latex and 14.85% to nitrile gloves. All 175 individuals showed type IV hypersensitivity, and none of them showed type I. Conclusion Latex gloves are not the only option for dentists who experience itching when wearing gloves; they can also use powered-free latex gloves and nitrile gloves or take precautions such as not using oil-based cream, washing their hands, or taking pharmaceuticals such as cetirizine, pheniramine maleate, etc. However, when symptoms worsen and include erythema, swelling, wheezing, and in some cases, anaphylactic shock may occur they tend to use alternative gloves.

19.
Cureus ; 15(10): e47030, 2023 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-37965401

RESUMO

A radicular cyst, also known as a periapical cyst or root end cyst, is a type of odontogenic cyst that is typically associated with permanent teeth. The radicular cyst usually is associated with maxillary central incisors followed by mandibular first molars. It occurs as a result of bacterial infection and pulpal necrosis which leads to inflammatory stimulation of the epithelial cell rests of Malassez along the periodontal ligament area of the tooth. Most cases of the radicular cyst are asymptomatic and they are diagnosed accidentally during routine radiographic examination. This article presents a case report of a 42-year-old male with an apical periodontal cyst associated with the maxillary anterior region. Early diagnosis and treatment planning is necessary. This article signifies the role of the surgeon in the early diagnosis and treatment plan of the cyst.

20.
Cureus ; 15(10): e46828, 2023 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-37954766

RESUMO

Dental implantology has witnessed remarkable advancements in recent years, and zirconia has emerged as a prominent biomaterial for dental implant applications. This review explores the multifaceted aspects of zirconia, focusing on its properties, processing methods, biocompatibility, mechanical performance, and clinical applications. Over the past few decades, the most popular choice of material for dental implantology has been titanium which has been found to have the highest success rate of implant treatment. However, recently, it has been observed that zirconia might replace titanium and eventually emerge as one of the gold-standard materials of dental implants. Analysis of biomechanical sciences and biomaterial sciences provides an opportunity for the refinement of design and material notions for surgical implants. However, the most important aspect and prime concern is how tissue at the implant site responds to biomechanical disturbances caused by foreign materials. The literature revealed that zirconia has certain characteristics that make it an excellent material for implants, including biocompatibility and osseointegration which depicts positive soft tissue response with low plaque affinity as well as aesthetics owing to light transmission and color. Additionally, this review discusses the current challenges and prospects of zirconia in dental implantology as well as aims to provide dental professionals and researchers with a comprehensive understanding of zirconia's potential as a biomaterial in dental implantology. The present overview of available literature intends to highlight and explore the biological characteristics of zirconia for applications in dental implantology. However, research is urgently required to fill in gaps over time for clinical assessments of all zirconia implants, consequently, the implementation of hybrid systems (a titanium screw with a zirconia collar) has recently been suggested.

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