Manfredini Mattia, Ghizzoni Martina, Cusaro Beatrice, Beretta Mario, Maiorana Carlo, Souza Francisley Ávila, Poli Pier Paolo
Maxillofacial Surgery and Dental Unit, Fondazione IRCCS Cà Granda Policlinico, 20112 Milan, Italy.
Department of Biomedical, Surgical and Dental Sciences, University of Milan, Via della Commenda 10, 20122 Milan, Italy.
Medicina (Kaunas). 2025 Jun 30;61(7):1187. doi: 10.3390/medicina61071187.
Implant primary stability is a prerequisite for obtaining osseointegration and clinical success. Insertion torque (IT) is measured during implant placement and is expressed in Ncm. It represents the quantification of the frictional force experienced by the implant as it progresses apically through a rotational motion along its axis. Usually, to achieve osseointegration, a value within the range of 20-40 Ncm is desirable. Below a threshold of 20 Ncm, implants have a decrease in survival rate, while implant stability is guaranteed above 20 Ncm. The main goal of this study was to evaluate whether high values of IT affect osseointegration, implant health, and healing, by highlighting the positive and negative effects of IT > 50 Ncm on peri-implant bone, soft tissues, and long-term stability. This scoping review considered randomized clinical trials, observational studies, and cohort studies. Studies failing to meet the predefined inclusion criteria were excluded from the analysis. The review process adhered to the Preferred Reporting Items for Scoping Reviews (PRISMA-ScR) guidelines. Ultimately, a total of 11 studies were included in the final synthesis. Based on the studies included, the literature suggests that high values of IT guarantee adequate primary stability and better osseointegration. However, high IT is significantly associated with greater marginal bone loss, depending on bone density. Accordingly, IT values > 50 Ncm may provoke greater compressive forces with a negative impact on the jawbone. An elevated strain on the bone can induce necrosis and ischemia, due to an alteration of circulation, which in turn is responsible for marginal bone loss and reduced osseointegration. Lack of osseointegration ultimately leads to an early implant failure. As concerns soft tissue recession, a higher decrease is measured in implants placed with high-insertion torque. Nonetheless, additional clinical trials are warranted to assess long-term outcomes, quantify the incidence of these complications, and explore the impact of emerging clinical variables.
种植体初期稳定性是实现骨结合和临床成功的前提条件。植入扭矩（IT）在种植体植入过程中进行测量，单位为Ncm。它表示种植体在沿其轴进行旋转运动向根尖方向推进时所经历的摩擦力的量化值。通常，为实现骨结合，理想的植入扭矩值范围在20 - 40 Ncm之间。低于20 Ncm的阈值，种植体的存活率会降低，而高于20 Ncm则可保证种植体稳定性。本研究的主要目的是通过强调IT > 50 Ncm对种植体周围骨组织、软组织和长期稳定性的正负影响，评估高植入扭矩值是否会影响骨结合、种植体健康及愈合情况。本范围综述纳入了随机临床试验、观察性研究和队列研究。未达到预先定义纳入标准的研究被排除在分析之外。综述过程遵循了范围综述的首选报告项目（PRISMA - ScR）指南。最终，共有11项研究纳入最终综合分析。基于纳入的研究，文献表明高植入扭矩值可保证足够的初期稳定性和更好的骨结合。然而，高植入扭矩与更大的边缘骨吸收显著相关，这取决于骨密度。因此，IT值> 50 Ncm可能会引发更大的压缩力，对颌骨产生负面影响。骨组织上的应变增加可导致坏死和局部缺血，这是由于血液循环改变所致，进而导致边缘骨吸收和骨结合减少。骨结合不足最终会导致种植体早期失败。关于软组织退缩，在高植入扭矩植入的种植体中测量到更高程度的退缩。尽管如此，仍需要更多的临床试验来评估长期结果，量化这些并发症的发生率，并探索新出现的临床变量的影响。
