Reverse torque testing and early loading failures: help or hindrance?

Reverse torque testing has been suggested to reduce the incidence of early loading failures during the first year of loading. However, the variables of bone density at stage II uncovery, the assessment of a small degree of implant rotation, and the effect of implant size and design have not been adequately evaluated. In addition, bone is weakest to shear forces, yet this is the primary force applied with reverse torque testing. This article reviews the benefits and disadvantages of reverse torque testing and suggests early crestal bone loss and failure of implants may be the result of this test, especially in less dense bone types. In addition, a nomenclature of implant failures is introduced to improve the correlation of information in the literature to the failure of implants in clinical practice.