18/10/2019 Placement of implants - Torque | FOR.

org

Back to explorer

TREATMENT GUIDELINES

Placement of implants - Torque

KEY POINTS

Torque can be measured by hand piece or torque wrench

Insertion torque describes the force necessary for implant insertion
Insertion torque is an objective surrogate measure for primary implant stability

Insertion torque level as a factor of implant success

Insertion torque represents the resistance of bone during implant placement. Since
too low a torque corresponds to low initial mechanical implant stability and too high
torque levels lead to avascular periimplant bone necrosis, implant
Login insertion
Sign up torque
should be carefully monitored and controlled.

Insertion torque and implant stability

Primary stability can be de ned as an absence of clinically detectable implant

mobility in the implant bed. Primary stability is mandatory for osseointegration and
implant success. An objective surrogate measure of primary stability is the
speci cation of the applied torque (Ncm) during the progress of implant insertion.
Torque depends on bone and implant parameters such as bone density, site
preparation/drill protocol, implant diameter and implant design. Reports in the
scienti c literature show that torque levels which are too low or too high can be
associated with implant failure. Insertion torques above 50 Ncm are unfavorable due
to excessive compressive stresses applied to the bone surrounding the implant.
Compressive stress leads to vessel obstruction which can limit periimplant bone
perfusion and induce bone necrosis. On the other hand, insertion torque should
exceed a minimum of torque measuring 30 Ncm. In situations of torque levels lower
than 30 Ncm an unloaded healing period of 4-6 months is recommended to enable
osseointegration. According to some studies minimal insertion torque of 40 Ncm
seems to be one of the prerequisites for a successful immediate loading procedure.
However, no conclusive evidence as to the minimum or maximum insertion torque
for di erent loading concepts to prevent implant failure exists.
EXPLORER
Techniques to determine insertion torque
LEARN ▾ on our website. Find out how we use
We use cookies to give you the best possible experience
Torque levels can be evaluated during the
cookies and how you can control them here. By continuinginsertion
to browseprogress with
the site you are help of a drilling
agreeing Ok, I agree
unit
to our useespecially designed for
of cookies.  Find out more torque documentation (Figure 1a) or by use of manual
ABOUT ▾
torque wrenches (Figure 1b). Both systems can measure torque levels during implant
https://www.for.org/en/treat/treatment-guidelines/edentulous/treatment-procedures/surgical/surgical-protocols-general/placement-implants-torque 1/5
18/10/2019 Placement of implants - Torque | FOR.org

insertion. The application of a drilling unit is user-friendly due to continuous

automatic torque monitoring. However, drilling units enabling torque-controlled
implant insertion are not appropriate to evaluate torque levels in bone of low
density.

Fig 1: Techniques to evaluate insertion torque:hand-piece (grey); torque wrench

(yellow).

RELATED ARTICLES

TREATMENT GUIDELINES

EXPLORER

LEARN ▾ on our website. Find out how we use

We use cookies to give you the best possible experience
cookies and how you can control them here. By continuing to browse the site you are agreeing Ok, I agree
to our use of cookies.  Find out more
ABOUT ▾
https://www.for.org/en/treat/treatment-guidelines/edentulous/treatment-procedures/surgical/surgical-protocols-general/placement-implants-torque 2/5
18/10/2019 Placement of implants - Torque | FOR.org

CHOICE OF IMPLANT

The majority of commercially available implants are variations of Brånemark’s

original design of a screw which he coined as ' xtures'. This has been the starting
point for numerous current market variations that incorporate convergent themes of
implant material...

Implant designs Implant surfaces

SCIENTIFIC REFERENCES

Esposito M, Grusovin MG, Maghaireh H, Worthington HV.Interventions for

replacing missing teeth: di erent times for loading dental implants.Cochrane
Database Syst Rev. 2013 Mar 28;3:CD003878. doi:
10.1002/14651858.CD003878.pub5. Review.
Duyck J, Corpas L, VermeireDuyck J, Corpas L, Vermeiren S, Ogawa T, Quirynen M,
Vandamme K, et al.. Histological, histomorphometrical, and radiological
evaluation of an experimental implant design with a high insertion torque. Clin
Oral Implants Res 2010;
Cannizzaro G et al. Immediate loading of 2 (all-on-2) versus 4 (all-on-4) implants
placed with a apless technique supporting... : 1-year results from a pilot
EXPLORER
randomized controlled trial. Eur J Oral Implants 2013;6(2):121-31.
Pagliani L, Sennerby L, Andersson P, Verrocch D, Meredith N. Insertion Torque
LEARN
We use cookies to give you the
Measurements best possible
During Placement ▾Neoss
experience
of on ourImplants.
website. Find out howOsseointegration
Applied we use
cookies and how you can control them here. By continuing to browse the site you are agreeing Ok, I agree
Research 2008-6.
to our use of cookies.  Find out more
ABOUT ▾
https://www.for.org/en/treat/treatment-guidelines/edentulous/treatment-procedures/surgical/surgical-protocols-general/placement-implants-torque 3/5
18/10/2019 Placement of implants - Torque | FOR.org

QUESTIONS

Log in or register to post questions and answers.

SELECT YOUR LANGUAGE GET FULL ACCESS FOR FREE

Receive immediate access to this website

English
by signing up. Please log in if you already
have an account.

LOG IN OR SIGN UP

About Us Contact Us Privacy Policy Terms of Use

FOR on Twitter FOR on Facebook

FOR on YouTube FOR on Instagram

© 2019 FOR - Foundation for Oral Rehabilitation

We use cookies to give you the best possible experience on our website. Find out how we use
cookies and how you can control them here. By continuing to browse the site you are agreeing Ok, I agree
to our use of cookies.  Find out more

https://www.for.org/en/treat/treatment-guidelines/edentulous/treatment-procedures/surgical/surgical-protocols-general/placement-implants-torque 4/5
18/10/2019 Placement of implants - Torque | FOR.org

https://www.for.org/en/treat/treatment-guidelines/edentulous/treatment-procedures/surgical/surgical-protocols-general/placement-implants-torque 5/5