Chair of Oral Diagnostic and Surgical Sciences, Associate Professor of Periodontology, Mohammed Bin Rashid University of Medicine and Health Sciences, Hamdan Bin Mohammed College of Dental Medicine, Dubai, United Arab Emirates.
Honorary Associate Professor, Sir John Walsh Research Institute, Faculty of Dentistry, University of Otago, Dunedin, New Zealand.
Clin Implant Dent Relat Res. 2021 Jun;23(3):341-360. doi: 10.1111/cid.12993. Epub 2021 Mar 25.
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.
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.
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).
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.
目前的文献中，关于不同种植体植入扭矩值对种植体治疗的临床和影像学结果的影响尚不清楚。本系统评价和荟萃分析的目的是评估高植入扭矩值与常规植入扭矩值水平相比对种植体结局和并发症发生率的影响。
在电子数据库中搜索随机对照试验（RCTs）、非随机对照临床试验（NRCCTs）、前瞻性和回顾性队列研究，并通过检索相关牙科期刊进行补充。使用 Cochrane 协作风险偏倚评估工具评估随机和非随机研究的偏倚风险。使用统计软件进行数据分析。
共确定了 718 项研究，其中有 9 项研究纳入了 684 名参与者的 1229 个牙种植体。RCTs 的荟萃分析显示，总体种植体失败率没有明显偏向任何植入扭矩值，两组间差异无统计学意义（风险比 0.85；95%置信区间 0.07-10.52；P=0.90）。没有一项 RCT 进行了注册。非 RCTs 的二次分析也没有显示出任何统计学上的显著差异。总体荟萃分析显示，高（≥50 Ncm）和常规（<50 Ncm）植入扭矩值之间在种植体周围边缘骨丧失或生物学/技术并发症方面没有显著差异。
即使立即进行种植体修复/加载，也没有足够的证据支持使用高或常规植入扭矩值。当使用高或常规植入扭矩值进行种植体植入时，短期种植体失败率、边缘骨水平变化和并发症发生率相当。宽置信区间表明，结果不能用高或常规植入扭矩值的临床意义获益来解释。
