title: Insertion torque of immediate wide-diameter implants: a finite element analysis.
abstract: OBJECTIVE
  To use finite element analysis to investigate the influence of insertion torque on the stress distribution around an immediately placed oral implant.
  
  
  METHODS
  Finite element software was used to model a mandibular molar extraction socket. The properties of surrounding cancellous bone and thickness of cortical bone were modified to give four 3D finite element models (I, II, III, and IV). A wide-diameter tapered oral implant was modeled and inserted into the socket. Final insertion torques of 32, 50, and 70 Ncm were applied, and the stress profile in each model was evaluated. The maximum von Mises stresses along the buccal cortical bone adjacent to the implant neck were statistically analyzed to compare the three torque values and four bone models.
  
  
  RESULTS
  At the level of the cortical bone, the greatest von Mises stress levels were generated in model IV and diminished as the bone quality increased. Significant increase in stress values at the crestal bone level was observed in all models after using 70 Ncm compared with 32 Ncm. The maximum von Mises stresses at the cancellous bone were higher in model I and reduced with lower level of bone quality (model IV).
  
  
  CONCLUSIONS
  The use of 70 Ncm or more insertion torque during placement of an immediately placed wide-diameter implant substantially increases stresses on the crestal bone. The development of a modified surgical protocol involving moderate insertion torque value (32 to 50 Ncm) may contribute to minimizing the risk of early implant failure in extraction sockets.
authors.affiliation: Sir John Walsh Research Institute, School of Dentistry, University of Otago, Dunedin, New Zealand. maatieh@gmail.com
authors.forename: Momen A
authors.initials: MA
authors.lastname: Atieh
authors.forename: Nabeel H M
authors.initials: NH
authors.lastname: Alsabeeha
authors.forename: Alan G T
authors.initials: AG
authors.lastname: Payne
authors.forename: Donald R
authors.initials: DR
authors.lastname: Schwass
authors.forename: Warwick J
authors.initials: WJ
authors.lastname: Duncan
mesh_terms: D001696:Biomechanical Phenomena; D015519:Bone Density / Q000502:physiology; D003198:Computer Simulation; D017076:Computer-Aided Design; D003758:Dental Implantation, Endosseous / Q000379:methods*; D015921:Dental Implants; D017267:Dental Prosthesis Design; D055119:Elastic Modulus; D020342:Finite Element Analysis; D006801:Humans; D021621:Imaging, Three-Dimensional / Q000379:methods; D008334:Mandible / Q000033:anatomy & histology / Q000502:physiology; D008954:Models, Biological; D008963:Molar; D013314:Stress, Mechanical; D013499:Surface Properties; D020390:Tooth Socket / Q000033:anatomy & histology / Q000502:physiology; D019415:Torque
chemical_list: D015921:Dental Implants