Initial Torque Stability of a New Bone Condensing Dental Implant. A Cohort Study of 140 Consecutively Placed Implants
The aim of this paper was to determine the torque resistance of this new implant during placement in different types of bone, immediate placement into sockets, and in grafted bone. The torque at time of placement serves as an indication of initial stability, which is accepted as an important factor for implant osseointegration and immediate loading. Within a 13-month period, 140 NobelActive implants in 84 consecutive patients were placed into types I–IV bone in fresh sockets, and into grafted bone (both in maxillary sinuses and on the facial alveolar surfaces where bone had been lost). The final torque was measured with a manual torque control wrench as manufactured by Nobel Biocare for clinical use with this type of implant. One hundred forty implants with 3.5 to 5 mm diameters and 10 to 15 mm lengths were placed in different types of bone, either as delayed or immediate implants into fresh extraction sockets. These implants demonstrated a mean torque stability value of 50.8 Ncm. The average insertion torque for delayed implants was 49.7 Ncm. For immediate implants the average torque was 52.6 Ncm. Placement into soft bone was also favorable at an average of 47.9 Ncm. Typical straight walled and tapered implants generally exhibit 10 to 35 Ncm insertion torques. The NobelActive implant consistently reaches higher torque levels. This may indicate they are more favorably suited to early provisionalization and loading. Soft bone (type IV) did not seem to decrease significantly the torque of insertion of these implants. Further longer term studies are needed to investigate whether this indeed makes these implants more suited for early provisionalization and loading than traditional root form. Long term studies are also needed to investigate maintenance of bone levels surrounding these implants.Abstract
The manual torque wrench for the NobelActive system by Nobel Biocare is gold in color (in contrast to the silver one for its other implant systems) and allows controlled torque as measured up to 70 Ncm.
Figure 2. This is a narrow platform NobelActive implant with dimensions 3.5 × 13 mm, used most commonly in narrower clinical situations such as the upper laterals and lower incisors. Figure 3. This is a regular platform NobelActive implant with dimensions 4.3 × 13 mm that can be used in almost any situation with the appropriate treatment plan. Figure 4. The regular platform implants in this system come in 2 different body widths, ie, 4.3 mm and 5.0 mm, without the actual prosthetic platform changing. This is a regular platform NobelActive implant with dimensions 5.0 × 10 mm. Therefore, the actual prosthetic components for this particular implant would fit in the one depicted in Figure 3 as well.
Implant width and bone quality as it relates to implant torque during initial placement at time of surgery.
Contributor Notes
Tassos Irinakis, DDS, MSc, is director of Graduate Periodontics and Implant Surgery, Faculty of Dentistry, University of British Columbia (UBC); he is also clinical associate professor in periodontics at UBC. Dr Irinakis is a certified specialist in periodontics. Address correspondence to Dr Irinakis at Faculty of Dentistry, University of British Columbia, 2199 Wesbrook Mall, Vancouver, BC, V6T 1Z3. (e-mail: bone.grafting@ gmail.com) Colin Wiebe, DDS, MSc, is a clinical associate professor in periodontics, Faculty of Dentistry, University of British Columbia and clinical associate professor, Department of Surgery, Faculty of Medicine, University of Calgary. Dr Wiebe is also a certified specialist in periodontics.