Dental News - The clinical effects of insertion torque for implants placed in healed ridges: A two-year randomized controlled clinical trial

Dr. Fortunato Alfonsi et al.

Tue. 17. January 2017

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Several factors are involved in the achievement of implant primary stability, such as the insertion torque, the implant’s macrogeometry, the surgical technique, and the bone quality and quantity. Implant primary stability is considered one of the key factors for osseointegration and is associated with insertion torque. Several studies have suggested that insertion torque values of 25–45 N cm could prevent micromovements that could impair the bone healing around the implants. The aim of the present randomized clinical trial was to evaluate and compare the clinical outcome for implants placed with a high insertion torque (50–100 N cm) and a regular insertion torque (within 50 N cm) in healed ridges after two years.

Materials and methods
Patients requiring implant therapy to replace missing teeth without the need for bone augmentation at the time of implant placement were selected for this study. All of the patients were divided according to a randomization list into two groups: high insertion torque (CT implants inserted with insertion torque ≥ 50 N cm) and regular insertion torque (Blossom CT implants with insertion torque < 50 N cm). The implants were left to heal submerged for three months and then restored with individualized abutments and cemented metal–ceramic crowns. Variables registered were insertion torque values, thickness of the buccal bone plate after implant osteotomy preparation, marginal bone level and facial soft-tissue level. All of the patients were followed for two years after implant placement, with recall visits at three, six, 12 and 24 months.

Results
116 implants were placed: 58 implants were allocated to each group, with mean insertion torque ranging from 20 N cm to 50 N cm for regular insertion torque and from 50 N cm to 100 N cm for high insertion torque. Three implants failed. Two implants showed at the 12-months evaluation a marginal bone loss > 1.5 mm and were thus considered unsuccessful.

Conclusion
Implants inserted with a high insertion torque in healed bone ridges showed more periimplant bone remodeling and facial soft-tissue recession than implants inserted with regular insertion torque after two years, both in the maxilla and in the mandible. The findings suggest that the clinician should pay attention to several factors in implant therapy, such as the thickness of the buccal bone, the corticalization of the surgical site, the implant’s macrogeometry and the potential influence of insertion torque on implant therapy outcomes.

Editorial note: The full article was published in the 4/2016 issue of the Journal of Oral Science and Rehabilitation. It can be access free of charge at www.dtscience.com.

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