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High Insertion Torque-Clinical Implications and Drawbacks: A Scoping Review.

Mattia Manfredini1,2, Martina Ghizzoni1,2, Beatrice Cusaro1,2

  • 1Maxillofacial Surgery and Dental Unit, Fondazione IRCCS Cà Granda Policlinico, 20112 Milan, Italy.

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Summary

High insertion torque (IT) ensures primary implant stability and better osseointegration. However, excessive IT (> 50 Ncm) can lead to marginal bone loss and soft tissue recession, potentially impacting long-term implant success.

Keywords:
dental implanthigh torqueimplant failureinsertion torquemarginal bone lossperiimplantitisprimary stability

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Area of Science:

  • Dental Implantology
  • Biomaterials Science
  • Surgical Outcomes Research

Background:

  • Primary implant stability is crucial for osseointegration and clinical success.
  • Insertion torque (IT), measured in Ncm, quantifies frictional forces during implant placement.
  • Optimal IT for osseointegration is typically between 20-40 Ncm; values below 20 Ncm decrease survival rates.

Purpose of the Study:

  • To evaluate the effects of high insertion torque (IT > 50 Ncm) on osseointegration, implant health, and healing.
  • To identify the positive and negative impacts of high IT on peri-implant bone, soft tissues, and long-term stability.

Main Methods:

  • A scoping review adhering to Preferred Reporting Items for Scoping Reviews (PRISMA-ScR) guidelines.
  • Inclusion of randomized clinical trials, observational studies, and cohort studies.
  • Analysis of 11 selected studies to synthesize findings on insertion torque and implant outcomes.

Main Results:

  • High IT values generally ensure adequate primary stability and enhance osseointegration.
  • Significantly associated with increased marginal bone loss, influenced by bone density.
  • IT > 50 Ncm may induce excessive compressive forces, potentially causing bone necrosis, ischemia, and soft tissue recession.

Conclusions:

  • While high IT promotes initial stability and osseointegration, excessive levels pose risks.
  • Potential complications include marginal bone loss, reduced osseointegration, and soft tissue recession.
  • Further clinical trials are needed to assess long-term outcomes and quantify complication incidence.