IMPLANT DENTISTRY / VOLUME 0, NUMBER 0 2015 1

Influence of Torsional Strength on

Different Types of Dental
Implant Platforms
Ana Beatriz V. Teixeira, DDS,* Antônio Carlos Shimano, DDS, MS, PhD,† Ana Paula Macedo, MS, PhD,‡
Mariana L. C. Valente, DDS,§ and Andréa C. dos Reis, DDS, MS, PhDk

sseointegrated implants are Aim: The study assessed defor- 80 N$cm with no statistical differ-

O a widely used alternative treat-

ment in oral rehabilitations of
partially and completely edentulous
patients.1 Although this is a highly
successful clinical procedure, treat-
ment depends on many factors such
as bone, implant-abutment, and abut-
ment-prosthesis interfaces.1,2 Mechani-
cal complications are common, and the
most frequent problem occurs at the
implant-abutment interface, such as
loosening of the screw that connects
the prosthesis to the implant,3 which
leads to complications such as over-
loading at the implant-bone interface.4,5
The forces generated by torque when
inserting the implant can cause morpho-
logical changes in the internal and exter-
nal implant surface. If torque generated
by a dentist is greater than the maximum
mation of implant components sub-
mitted to torsion tests of 80 and 120
N$cm using an optical stereomicro-
scope.
Material and Methods: The fol-
lowing 3 types of Titaniumfix conical
implant connections (n ¼ 5) measur-
ing Ø 4.0 3 11.5 mm were used:
external, internal hexagon and Morse
taper connections. The diagonal and
lateral measurements of the hexagon
implant platform were measured
before and after the torsion test.
Results: The torsion test using
torque of 80 and 120 N$cm altered
the implant dental platforms. All
groups presented deformation of
implant component after torque of
ence among them. During torque of
120 N$cm, a difference in the Morse
taper connection in relation to the
internal and external hexagon con-
nection was observed. The Morse
taper connection implant, followed
by the internal hex implant, under-
went less deformation. Greater
deformation occurred in the external
hex implants.
Conclusion: For all the im-
plants, high insertion torques
deformed the implant platform pre-
venting long-term maintenance and
stability of implants. (Implant Dent
2015;0:1–6)
Key Words: dental implant, torsion,
material testing, implant platform

*Postgraduate Student, Department of Dental Materials and

Prosthodontics, Dental School of Ribeirão Preto, University of
São Paulo, Ribeirão Preto, São Paulo, Brazil.
†Associate Professor, Department of Biomechanics, Medicine
and Rehabilitation of the Locomotor System, Medicine School of torque force supported by the screw, it external or internal. Greater stability is
Ribeirão Preto, University of São Paulo, Ribeirão Preto, São
Paulo, Brazil. may cause rupture of implant and bone, correlated with internal connections in
‡Research Laboratory Specialist, Department of Dental
Materials and Prosthodontics, Dental School of Ribeirão Preto, internal thread stripping, deformation of which the walls of the prosthetic compo-
University of São Paulo, Ribeirão Preto, São Paulo, Brazil.
§Postgraduate Student, Department of Dental Materials and implant platform, and damage to primary nent are in close contact with the internal
Prosthodontics, Dental School of Ribeirão Preto, University of
São Paulo, Ribeirão Preto, São Paulo, Brazil. stability and bone-implant interface.1,6,7 surface of the implant,3,10 reducing the
kTitular Professor, Department of Dental Materials and In different implant systems and possibility of micromovements during
Prosthodontics, Dental School of Ribeirão Preto, University of
São Paulo, Ribeirão Preto, São Paulo, Brazil. connections, the connection between the the application of loads.11,12
Reprint requests and correspondence to: Andréa C. dos
implant and abutment depends on the In terms of implant-abutment
Reis, DDS, MS, PhD, Departamento de Materiais screw preload, which predetermines connection, different types of systems
Dentários e Prótese, Faculdade de Odontologia de the amount of torque for each system.1 have been used clinically, such as the
Ribeirão PretodFORP-USP, Av. do Café, s/n 14040-
904, Ribeirão Preto, SP, Brazil, Phone: +55-16-3602- The implants configuration is an essential external and internal hexagonal con-
4044, Fax: +55-16-3315-4780, E-mail: andreare73@ condition for the better distribution of nections, and the Morse taper connec-
yahoo.com.br
forces, reducing load on the underlying tion depending on the clinical case.13
ISSN 1056-6163/15/00000-001 bone.8,9 From a biomechanical point of Internal hexagon implants support
Implant Dentistry
Volume 0  Number 0 view, the major difference between the torque close to 80 N$cm and rupture
Copyright © 2015 Wolters Kluwer Health, Inc. All rights
reserved. implant dental connections is the hexa- torque above 150 N$cm. The external
DOI: 10.1097/ID.0000000000000247 gon-shaped connections, which can be hexagon implants, inserted with

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 2 INFLUENCE OF TORSIONAL STRENGTH  TEIXEIRA ET AL

implant assembly, may deform when

torque exceeds 55 N$cm and strip with
torque close to 70 N$cm, which frac-
tures the implant assembly before de-
forming the implant platform.14 The
stability of the Morse taper connection
is superior in comparison with other
types of connections because it causes
less stress on the abutment screw.1
The application of opposing forces
on the implant-supported prostheses
may cause the loosening of the abut-
ment screw or failure of osseointegra-
tion due to the excess of loads
generated in the surrounding bone.8 Fig. 1. Image captured by optical stereomicroscope and measurement of the implant plat-
Due to the lack of studies in the forms: (A) diagonal measurement; (B) lateral measurement.
literature and the need to understand the
biomechanics of the implant connection
systems, the aim of this study was to Torsion Test screws were placed in a vise keeping
evaluate microscopically the deformation The manual torsion test was per- their hexagonal recess facing upwards
of different platforms submitted to the formed with the aid of a digital torque and leaving 5 threads free as required by
manual torsion test, which is widely used meter (Mackena, São Paulo, Brazil) the NBR ISO 6475.15
by the manufacturers to test implants. model MK-20XX, with maximum With one part of the hexagonal
MATERIALS AND METHODS capacity of 2000 N$cm and precision fitting of the torque meter coupled to
of 0.01 N$cm to quantify the torque the hexagonal head of the screw, an
Fifteen implants manufactured in
applied to the screw at each angle. The angle of 90 degree angle was maintained
grade IV titanium, supplied by Titanium-
fix (São José dos Campos, SP, Brazil),
were used to conduct the study. All im-
plants were of equal size (Ø 4.0 3 11.5
mm) and shape (cylindrical) differing on-
ly in the type of implant connection:
external hexagon (e-fix) (Titaniumfix,
São José dos Campos, SP, Brazil), inter-
nal hexagon (i-fix) (Titaniumfix, São
José dos Campos, SP, Brazil), and Morse
taper connections (c-fix) (Titaniumfix,
São José dos Campos, SP, Brazil). All
implants were submitted to microscopic
analysis of the implant platform and
manual torsion test.
Microscopic Analysis of
Implant Platform
For a detailed analysis of the implant
platform, the S8AP0 optical stereomi-
croscope (Leica Geosystems, Heer-
brugg, Switzerland) was used at 320
magnification. The images were evalu-
ated using the Leica Application Suite
V3 software (Leica Microsystems,
Wetzlar, HE, Germany). The diagonal
(Fig. 1A) and lateral (Fig. 1B)
measurements of the hexagon platform
were performed before the torsion test
(I) and after torque application of 80
N$cm (T80) and 120 N$cm (T120). De-
formations were obtained by comparing Fig. 2. Schematization of torsion test using the torque meter.
T80-I, T120-I, and T120-T80.

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 IMPLANT DENTISTRY / VOLUME 0, NUMBER 0 2015 3

Table 1. Mean Values (SD) of the Diagonal Measurements of the Implants in the
Optical Stereomicroscope Obtained by Comparing the Deformations: T80-I, T120-I,
and T120-T80
Implants T80-I (mm)
E-FIX 0.01 (0.02)*$£
C-FIX 0.03 (0.02)*$£
I-FIX 0.02 (0.00)*$£
The symbols *$£ represents statistical differences with torques in line.
The lower case letters represents statistical difference with groups.
between the arm of the torque meter and
the longitudinal axis of the screw. Cir-
cular motion began in a clockwise direc-
tion at speed within the required values
(1–5 rotations per minute) until reaching
80 N$cm. Removal of the fitting and
deformation were evaluated.16 After the
evaluation, the procedure was repeated
until torque of 120 N$cm was reached. A
new evaluation of the deformation was
performed (Fig. 2).
Statistical Analysis
The statistical program SPSS (ver-
sion 17.0) (IBM Statistical Product
and Service Solutions, Chicago, IL,
USA) was used for the statistical
analysis. Initially, analyses of norma-
lity (Kolmogorov-Smirnov) were per-
formed. Once normality was verified,
the parametric generalized linear model
for repeated measures was applied at
a 5% significance level. Bonferroni post
hoc test was used to differentiate the
mean values.
RESULTS
The T80-I symbology is the differ-
ence between the measurements made
Fig. 3. Graphs of measurements of the implants in the optical stereomicroscope obtained by
comparing the deformations: T80-I, T120-I, and T120-T80: (A) diagonal measurement; (B)
lateral measurement.
T120-I (mm) T120-T80 (mm)
−0.07 (0.02)*$a −0.08 (0.00)£$c
0.00 (0.02)*$ab −0.03 (0.01)£$c
−1.14 (1.49)*$b −1.16 (1.49)£
after the torque of 80 N$cm and the initial
analysis (before the torsion test), and
T120-I represents the difference between
the measurements after 120 N$cm torque
and the initial analysis. Already, the
T120-T80 symbology means the values
of measurements made after torque of
120 N$cm least the measurements made
after the torque of 80 N$cm.
Diagonal Measurements
No difference was found among the
experimental groups when 80 N$cm tor-
que (T80-I) was applied. Thus, all im-
plants underwent similar deformation.
After 120 N$cm torque (T120-I),
a statistical difference was found
between the Morse taper and external
hexagon implants (P ¼ 0.001) and
between the Morse taper and internal
hexagon implants (P ¼ 0.028). Less
deformation occurred for the Morse
taper implants and greater deformation
for the external and internal hexagon
implants, respectively.
A difference was found between
the Morse taper and external hexagon
implants (P ¼ 0.005) when comparing
the deformation caused by torque of
120 N$cm and 80 N$cm (T120-T80).
Comparing the deformation of
each group of implants, it was observed
that the Morse taper implant T80-I and
T120-I showed a significant difference
(P ¼ 0.006), as well as T120-I and
T120-T80 (P ¼ 0.010); a difference
was also found in the T80-I and T120-
T80 implants (P ¼ 0.002). Thus, the
torque applied to this type of implant
generated significant deformation.
For the external hexagon implant,
a significant difference (P , 0.000) when
comparing T80-I and T120-I, and T80-I
and T120-T80 (P , 0.000). No differ-
ence was found when T120-I and
T120-T80 were compared (P ¼ 0.781).
Significant deformation was found when
80 N$cm torque was applied to the
implant, but no significant deformation
was found when comparing the deforma-
tion caused by 80 N$cm to 120 N$cm.
A significant difference was found in
the internal hexagon implant when com-
paring T80-I and T120-I (P , 0.000) and
T80-I and T120-T80 (P , 0.000). No
difference was found when T120-I and
T120-T80 were compared (P ¼ 0.596).
Significant deformation was found when
80 N$cm torque was applied, but no sig-
nificant deformation was found when
comparing the deformation caused by 80
N$cm and 120 N$cm (Table 1, Fig. 3A).
Lateral Measurements
No difference was found among the
experimental groups when 80 N$cm tor-
que was applied (T80-I). Thus, all im-
plants underwent similar deformation.
After application of 120 N$cm tor-
que (T120-I), a statistical difference
was found between the Morse taper im-
plants and external hexagon implants
(P ¼ 0.003) and between the Morse
taper and internal hexagon implants
(P ¼ 0.012). Less deformation occurred
to the Morse taper implants and greater
deformation to the external and internal
hexagon implants. A difference was
found between Morse taper and exter-
nal hexagon implants (P ¼ 0.002) and
between Morse taper and internal hexa-
gon implants (P ¼ 0.008) when com-
paring deformation of T120-T80.
Comparing the deformation of
each experimental group, it was
observed that the Morse taper implants
did not undergo significant deformation
at different torques.

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 4 INFLUENCE OF TORSIONAL STRENGTH  TEIXEIRA ET AL

Table 2. Mean Values (SD) of the Lateral Measurements of the Implants in the Optical
Stereomicroscope Obtained by Comparing the Deformations: T80-I, T120-I, and
T120-T80
Implants T80-I (mm)
E-FIX 0.01 (0.02)*$£
C-FIX 0.01 (0.02)
I-FIX 0.01 (0.01)*$£
The symbols *$£ represents statistical differences with torques in line.
The lower case letters represents statistical difference with groups.
A significant difference (P ,
0.000) was found in the internal hexa-
gon implant when comparing T80-I
and T120-I, which was also observed
in T80-I and T120-T80 (P , 0.000).
No difference was found when T120-I
and T120-T80 were compared (P ¼
0.971). Significant deformation was
found when 80 N$cm torque was
applied to the implant, but no signifi-
cant deformation was found when
comparing deformation caused by 80
N$cm and 120 N$cm.
A significant difference (P ,
0.000) was found in the internal hexa-
gon implants when comparing T80-I
and T120-I, and T80-I and T120-T80
(P , 0.003). No difference was found
when T120-I and T120-T80 were com-
pared (P ¼ 1.000). Significant deforma-
tion was found when 80 N$cm torque
was applied to the implant, but no sig-
nificant deformation was found when
torque of 80 and 120 N$cm were
applied (Table 2, Fig. 3B).
DISCUSSION
The implant configuration differs
by type of implant connection that can
be external or internal indexed con-
nection. The implant/abutment con-
nection is the weakest interface
between the connectors and endo-
sseous implants as it must withstand
masticatory forces and penetration of
bacteria.17
This study shows that high torque
alters the implant platform. This con-
firms the need to establish a standard
torque of 40 to 45 N$cm when inserting
implants18 with the purpose of prevent-
ing failure of the prosthesis that, under
mechanical stress, may cause move-
ment of the abutment and increase
space at the implant/abutment interface
T120-I (mm) T120-T80 (mm)
−0.07 (0.02)*$a −0.07 (0.01)£$c
0.00 (0.02)ab −0.02 (0.01)cd
−0.06 (0.02)*$b −0.07 (0.03)£$d
favoring bacterial penetration, which
may lead to periimplantitis.19
The study of Rocha20 showed that
the internal hex implant platform sup-
ports torques close to 80 N$cm with-
out undergoing deformation. Thus, we
began applying torque of 80 N$cm to
assess the value of torque that causes
the deformation of the implant
platform in the experimental groups.
Contradicting the results of Rocha,20
the implants tested in this study
found that the platforms underwent
alterations at torques of 80 and 120
N$cm, which shows that higher tor-
ques can damage the implant-prosthe-
sis connection.
Studies show that the higher the
primary stability is, the better is osseoin-
tegration,21,22 but the results obtained
show that the application of high torque
levels to obtain good primary stability
can cause changes in the implant plat-
form and thus jeopardize the success of
the rehabilitative treatment.
Despite all implants deforming at
torque of 80 N$cm, the Morse taper
group showed the lowest deformation
rates in comparison with the internal
and external hexagon implants. The
external hex implant connection
showed the highest deformation rates
in the implant platform.
The Morse taper connection
showed better results when compared
with other systems as its platform
underwent less deformation, which
favors stability of the prosthesis,
prevents bacterial colonization, and
minimizes marginal bone loss.1,17
When applying torque, the sides of
the implant platform in the experimen-
tal group showed no statistically sig-
nificant deformation as the alteration
was small according to the distance
of the lateral sides. The diagonal sides
showed significant difference between
torques; because the distance was
greater, deformation was noticed. No
rotational movements of the abutment
or microgap enlargement of the taper
connection implants under vertical
and oblique occlusal load are dis-
cussed in the literature; however,
external and internal connection
systems are more susceptible to micro-
movements.23,24 In the taper connec-
tion implants, the space between
the implant/abutment interface is
smaller, retarding or preventing bacte-
rial colonization.1,25
Mechanical stability of the com-
ponents of implant-supported prosthe-
ses is important for the success of
rehabilitation. The loosening of the
abutment screw is a technical problem
that occurs mainly in the external
hexagon implant system due to pre-
load loss.26 Thus, adequate insertion
torque is important to prevent loss dur-
ing occlusal loading and consequent
loosening of the abutment screw.26
Furthermore, deformation of the
implant platform with high insertion
torques may damage the seating of
the intermediate component, which
can lead to premature loosening of
the abutment screw, cause failure,
and require more consultations to
tighten the screw.27
An important factor for the main-
tenance of long-term stability of
implant/abutment is to maintain the
value of torque after tightening of
abutment screw, which can prevent
the loosening of the abutment screw
and formation of microspace. All types
of implant connection showed loss of
torque, but the Morse taper implant is
more resistant to loss than the other
systems.
The fitting of the implant platform
area justifies the results. Devices were
fabricated for the implant platform
connection for the torque meter to
conduct the torsion test. In the external
hexagonal implant, the device was
adapted directly onto the platform,
which had reduced height and contact
area. Moreover, the device used for the
internal hexagon and Morse taper
implant were connected internally to
the implant, thus because of the
presence of greater internal contact

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surface and wall thickness of the
screw, these types of connection
offered greater stability. According
to Mangano et al,1 the Morse taper im-
plants offer greater mechanical stabil-
ity when the external hex connections
are purchased, resulting in greater
long-term clinical performance, low
failure rate, and less biomechanical
complications.
The success rate of the rehabilita-
tion treatment with implant-supported
prostheses depends on the close contact
between the bone and implant, thus
primary stability is a prerequisite to
achieve osseointegration,1 so that the
loads applied on the prosthesis be
evenly transmitted and distributed in
the surrounding bone. The concentra-
tion of stresses generated by the inser-
tion torque may exceed the tolerance
level of the bone and induce bone
resorption1 and cause the deformation
of the implant platform and prosthetic
components.5,23
One way of reducing these unex-
pected events is the correct selection of
the type of implant and prosthetic
platform during planning and knowing
the real value of torque required for
fixing the abutment. Inadequate incli-
nation, poorly fit prosthesis, and occlu-
sion problems cause the loosening of
the screw, which leads the dentist to
believe that higher torque levels can
overcome these problems. However,
this only causes the deformation of the
implant platform, which aggravates an
existing problem (aforementioned).28
Thus, it can be stated that despite the
Morse taper implants being more resis-
tant to high torque levels, torque should
never exceed the one specified by the
manufacturer.
CONCLUSION
It may be concluded that the Morse
taper implants showed the lowest deck
deformation, followed by internal hexa-
gon, and the largest deformation
occurred in the external hex implants.
Thus, the torsion test caused deforma-
tions to the implant platform tested
showing that high insertion torques
jeopardize the implant platform pre-
venting long-term stability and mainte-
nance of prosthesis.
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IMPLANT DENTISTRY / VOLUME 0, NUMBER 0 2015
DISCLOSURE
The authors claim to have no
financial interest, either directly or
indirectly, in the products or informa-
tion listed in the article.
ACKNOWLEDGMENTS
The authors thank FAPESP (São
Paulo State Research Support Foun-
dation) for the scientific initiation
scholarship (process number: 2010/
16201-7). The authors also thank Pro-
fessor Rossana Pereira de Almeida
Antunes for providing the optical ste-
reomicroscope.
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