The influence of insertion torque values on the failure and complication rates of dental implants: A systematic review and meta‐analysis

Abstract

Background The influence of using different insertion torque values on clinical and radiographic outcomes of implant therapy is unclear in the current literature. The aim of this systematic review and meta‐analysis was to evaluate the implant outcomes and complications rates using high insertion torque values compared with those using regular insertion torque value levels. Methods Randomized controlled trials (RCTs), nonrandomized controlled clinical trials (NRCCTs), prospective and retrospective cohorts were searched for in electronic databases and complemented by hand searching relevant dental journals. The risk of bias was assessed using the Cochrane Collaboration's Risk of Bias tool for randomized and nonrandomized studies. Data were analyzed using a statistical software. Results A total of 718 studies were identified, of which, nine studies were included with 1229 dental implants in 684 participants. The meta‐analysis of RCTs showed that the overall implant failure rate was not notably in favor of any insertion torque value and the difference between the two groups was not statistically significant (risk ratio 0.85; 95% confidence interval 0.07–10.52; P = 0.90). None of the RCTs was registered. The secondary analyses of non‐RCTs did not either show any statistically significant difference. Overall meta‐analysis did not show any significant differences in peri‐implant marginal bone loss or biological/technical complications between high (≥50 Ncm) and regular insertion torque (<50 Ncm). Conclusions There is insufficient evidence to support the use of high or regular insertion torque even with immediate implant restoration/loading. The short‐term implant failure rates, changes in marginal bone level and complication rates were comparable when high or regular insertion torques were used for implant placement. The wide confidence interval indicated that results cannot be interpreted with clinically meaningful benefit for using either high or regular insertion torque.

Stability of Dental Implants and Thickness of Cortical Bone: Clinical Research and Future Perspectives. A Systematic Review

“…They also pointed out that, at implant sites where the cortical bone was more represented (mandible), the use of high IT produced the worst clinical effects. However, recent systematic reviews on this subject underline that studies concerning the association between high IT and marginal bone loss are still inconclusive, and more research is recommended on the matter [ 46 , 47 , 48 ].…”

Mandibular bone characteristics, drilling protocols, and final insertion torque for titanium‐zirconium mini‐implants for overdentures: A cross‐sectional analysis

“…24 However, when comparing high torque with regular torque values in respect to failure and complication rates, a systematic review with meta-analysis showed no significant difference in these short-term outcomes, at least concerning standard diameter implants. 25 The results of this study show that final insertion torque varies significantly depending on patients' clinical anatomy and the technical procedures employed during surgery. Concerning the drilling protocol, bone types I and II required full length preparation with the needle drill for achieving optimal torque, whereas in cases with low density bone, undersized drilling was required for reaching sufficient insertion torque.…”

“…Insertion torque has been shown to affect the outcome of mini implant treatment, with low torque being correlated with severe marginal bone loss cases 24 . However, when comparing high torque with regular torque values in respect to failure and complication rates, a systematic review with meta‐analysis showed no significant difference in these short‐term outcomes, at least concerning standard diameter implants 25 …”

Survival Rate of Dental Implants in the Cleft Area: A Cross-Sectional Retrospective Study

“…In our study, of the 50 implants that failed, 27 failed shortly (3.92%) and 23 failed long (3.34%) after the procedure, corroborating previous findings. 22 In this study, we grouped the provisional (14, acrylic resin crown) and metal-ceramic (9) prostheses in late failures since the masticatory loads are distributed in similar ways in both materials. 32 This study has several limitations due to its retrospective nature.…”