title: The Effect of Insertion Torque on the Clinical Outcome of Single Implants: A Randomized Clinical Trial.
abstract: BACKGROUND
  The insertion torque value has been extensively used as an indicator for implant primary stability, which is considered a determining parameter for the implants success.
  
  
  OBJECTIVE
  The primary goal of the present randomized clinical trial was to evaluate and compare the clinical outcome for implants placed with high insertion torque (between 50 Ncm and 100 Ncm) and regular insertion torque (within 50 Ncm) in healed ridges.
  
  
  METHODS
  Partially edentulous patients, missing one or more mandibular or maxillary teeth, having an adequate amount of bone, requiring implant placement, were randomized to receive Blossom CT implants with regular insertion torque (<50 Ncm) or CT implants with high insertion torque (≥50 Ncm). Implants were left to heal submerged for 3 months. Implants were restored with individualized abutments and cemented metal-ceramic crowns. Acquired measurements were: insertion torque values (IT), thickness of buccal bone plate after implant osteotomy preparation (BBT), marginal bone level (MBL), and facial soft tissue level (FST). All patients were followed 12 months after implant placement.
  
  
  RESULTS
  One hundred sixteen implants were placed in one hundred sixteen patients and enrolled for the study. Fifty-eight implants were randomly allocated in regular-IT and high-IT groups with a mean insertion torque ranging from 20 Ncm to 50 Ncm and from 50 Ncm to 100 Ncm, respectively. Three implants failed, and another five implants showed at the 12-month evaluation a marginal bone loss (ΔMBL) greater than 1.5 mm, being considered unsuccessful.
  
  
  CONCLUSIONS
  The findings suggested that implants inserted with high-IT (≥50 Ncm) in healed bone ridges showed more peri-implant bone remodeling and buccal soft tissue recession than implants inserted with a regular-IT (<50 Ncm). Moreover, sites with a thick buccal bone wall (≥1 mm) - after implant osteotomy site preparation - seemed to be less prone to buccal soft tissue recession after 12 months than sites with a thin buccal bone wall (<1 mm).
authors.affiliation: Department of Surgical, Medical, Molecular and Critical Area Pathology, University of Pisa, Pisa, Italy.|Tuscan Dental Institute, Versilia General Hospital, Lido di Camaiore (LU), Italy.
authors.forename: Antonio
authors.initials: A
authors.lastname: Barone
authors.affiliation: Tuscan Dental Institute, Versilia General Hospital, Lido di Camaiore (LU), Italy.
authors.forename: Fortunato
authors.initials: F
authors.lastname: Alfonsi
authors.affiliation: Department of Surgical, Medical, Molecular and Critical Area Pathology, University of Pisa, Pisa, Italy.|Tuscan Dental Institute, Versilia General Hospital, Lido di Camaiore (LU), Italy.
authors.forename: Giacomo
authors.initials: G
authors.lastname: Derchi
authors.affiliation: Department of Surgical and Translational Medicine, University of Florence, Florence, Italy.
authors.forename: Paolo
authors.initials: P
authors.lastname: Tonelli
authors.affiliation: Department of Surgical, Medical, Molecular and Critical Area Pathology, University of Pisa, Pisa, Italy.|Tuscan Dental Institute, Versilia General Hospital, Lido di Camaiore (LU), Italy.
authors.forename: Paolo
authors.initials: P
authors.lastname: Toti
authors.affiliation: Department of Surgical, Medical, Molecular and Critical Area Pathology, University of Pisa, Pisa, Italy.|Tuscan Dental Institute, Versilia General Hospital, Lido di Camaiore (LU), Italy.
authors.forename: Saverio
authors.initials: S
authors.lastname: Marchionni
authors.affiliation: Department of Surgical, Medical, Molecular and Critical Area Pathology, University of Pisa, Pisa, Italy.|Tuscan Dental Institute, Versilia General Hospital, Lido di Camaiore (LU), Italy.
authors.forename: Ugo
authors.initials: U
authors.lastname: Covani
mesh_terms: D000328:Adult; D000368:Aged; D016723:Bone Remodeling; D003758:Dental Implantation, Endosseous / Q000379:methods*; D019250:Dental Implants, Single-Tooth / Q000009:adverse effects; D005260:Female; D005881:Gingiva / Q000503:physiopathology; D005889:Gingival Recession / Q000209:etiology*; D006801:Humans; D057893:Immediate Dental Implant Loading / Q000379:methods; D008297:Male; D008875:Middle Aged; D019415:Torque; D016896:Treatment Outcome
keywords: delayed implants; delayed restored implant; insertion torque; marginal bone resorption; soft tissue recession