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Title No Difference in Peri-implant Marginal Bone Resorption or Failure Rates for Implants Placed at High vs. Low Insertion Torque Values
Clinical Question For a patient with dental implants, will low insertion torque compared to high insertion torque increase peri-implant marginal bone loss and implant failure rates?
Clinical Bottom Line For dental implants, there is no statistically significant difference in peri-implant marginal bone resorption when placed with high or low insertion torque values. This is supported by two separate systematic reviews which included several in vivo randomized controlled trials of both animals and humans. A higher insertion torque may be beneficial in cases of poorer bone quality and with a plan to immediate load the implant.
Best Evidence (you may view more info by clicking on the PubMed ID link)
PubMed ID Author / Year Patient Group Study type
(level of evidence)
#1) 27129002Berardini/2016Human Studies - 4, Animal Studies - 6, Implants Evaluated - 591Meta-Analysis
Key resultsIn the 10 studies (4 human and 6 animal subjects) included in this meta-analysis, a total of 348 implants were inserted with high insertion torque (>25 Ncm, up to 176 Ncm) and 243 implants inserted with low torque values (˂30–35 Ncm). No significant differences were detected for bone resorption in these studies. It can be suggested that there is no significant difference in marginal bone resorption and implant failure rate between implants inserted with high or low insertion torque values.
#2) 26252028Li/ 20156 Human studiesMeta-Analysis
Key resultsIn the 6 studies included in this meta-analysis, 258 implants were evaluated for insertion torque and marginal bone loss. Assessment of P-values (P>.05) showed no correlation between marginal bone resorption and high insertion torque. It can be suggested that marginal bone resorption around implants placed with high insertion torque(>50 Ncm) does not show a statistically significant difference from implants placed with conventional insertion torque (35 to 45 Ncm).
Evidence Search ("bone resorption"[MeSH Terms] OR ("bone"[All Fields] AND "resorption"[All Fields]) OR "bone resorption"[All Fields]) AND ("dental implants"[MeSH Terms] OR ("dental"[All Fields] AND "implants"[All Fields]) OR "dental implants"[All Fields]) OR "insertion"[All Fields]) AND ("torque"[MeSH Terms] OR "torque"[All Fields] OR "torques"[All Fields] OR "torqued"[All Fields] OR "torqueing"[All Fields] OR "torquing"[All Fields]))
Comments on
The Evidence
Validity: Even though both reviews only had one overlapping randomized control trial, the level of evidence presented was of poor overall quality. For example, in Bernardini/2016, there was a large amount of variation amongst the results of the individual studies. One randomized control trial also used a different type of implant in the control group than the test group and therefore yielded lower quality evidence. In Li/2015, only 2 studies (207 implants) had adequate data for meta-analysis, which may not be sufficient for drawing adequate conclusions. For bone resorption measured at time of early loading there exists a large amount of heterogeneity between these studies' results. The meta-analysis for bone resorption measured at 12 months is also weighted heavily towards only one study. Perspective: These systematic reviews summarized the best evidence published so far, concluding that there are no significant differences in marginal bone resorption or implant failure between dental implants inserted with high or low insertion torque values. More investigations are needed in order to provide a more confident answer.
Applicability The evidence provided by these reviews is applicable to all specialties treating patients with dental implants. Higher insertion torque values are believed to be associated with greater primary stability and more successful implant therapy. Evidence that there is no difference in the marginal bone resorption when placed at high torques when compared to low torque will give the clinician greater confidence in a successful outcome.
Specialty/Discipline (General Dentistry) (Oral Surgery) (Periodontics) (Prosthodontics) (Restorative Dentistry)
Keywords Dental implants, Insertion torque, bone loss, bone resorption
ID# 3436
Date of submission: 12/03/2020spacer
E-mail jessen@livemail.uthscsa.edu
Author Brett Jessen, DDS
Co-author(s) Julia Shelbourn, DMD
Co-author(s) e-mail helbourn@uthscsa.edu
Faculty mentor/Co-author David Lasho, DDS, MSD
Faculty mentor/Co-author e-mail lasho@uthscsa.edu
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