Views: 222 Author: Dream Publish Time: 2025-03-24 Origin: Site
Content Menu
● Understanding Dental Implant Placement
● The Dangers of Over-Tightening
>> Bone Compression and Necrosis
>> Delayed Biological Stability
>> Proper Training and Experience
● Managing a Potentially Over-Tightened Implant
>> Intervention
● FAQ:
>> 1. What is the ideal torque range for dental implant placement?
>> 2. What can happen if a dental implant is over-tightened?
>> 3. How can clinicians prevent over-tightening of dental implants?
>> 4. What are the signs of a failing dental implant?
>> 5. Can a loosened implant crown screw simply be retightened?
Dental implants are a popular and effective solution for replacing missing teeth, offering a long-lasting and natural-looking alternative to dentures and bridges. The success of a dental implant relies heavily on the meticulous surgical procedure and the body's ability to integrate the implant with the jawbone, a process known as osseointegration[5]. However, even with careful planning and execution, complications can arise, one of which is the over-tightening of the dental implant. This article delves into the potential consequences of over-tightening a dental implant, its causes, and preventative measures.
During dental implant placement, the dentist or oral surgeon carefully inserts a titanium screw into the jawbone to act as an artificial tooth root[5]. The amount of force, or torque, applied during this insertion is critical. Insufficient torque can lead to instability, while excessive torque can damage the surrounding bone tissue[2].
The ideal torque range for dental implant placement is generally between 23 to 35 Ncm (Newton centimeters)[3]. Some clinicians prefer higher insertion torque, whereas others do not[8]. This range allows for optimal primary stability, which is the initial mechanical fixation of the implant in the bone[3]. Primary stability is essential for successful osseointegration, as it minimizes micromovement of the implant during the healing process[3].
Over-tightening an implant can lead to excessive compression of the bone around the implant[1]. This compression can disrupt blood flow to the bone cells, leading to necrosis, or bone death[1][2]. Necrosis impairs the bone's ability to integrate with the implant, increasing the risk of implant failure[1].
High insertion torque can damage bone and delay healing rates for implant's secondary or biological stability[2]. While high torque may initially provide primary stability, it can impair the development of secondary stability, which is the biological bonding of the bone to the implant surface[2]. Studies suggest that high torque at placement contributes to reduced bone-to-implant contact, hindering long-term stability[2].
Ultimately, over-tightening a dental implant can lead to implant failure[1]. If the bone around the implant is damaged or unable to integrate properly, the implant may become loose, painful, or infected, requiring its removal[1][5].
In practice, insertion torque can be subjectively assessed by the surgeon using manual ratchets or objectively by using electronic drill devices having torque measuring capability[8]. Most of the prevalent implant systems used in routine clinical practice do not have electronic torque measuring component, instead a non-calibrated manual ratchet is used[8]. Hence, it depends on the surgeon's experience to judge it[8].
In some cases, clinicians may over-tighten an implant due to a lack of precision or control during the placement procedure. This can occur when using manual instruments or when the clinician does not have sufficient experience in implant placement[8].
Another possible source of the problem may be the torque driver used to tighten the screw to achieve the proper preload target torque[6]. Dental implant torque tools are designed to assist the clinician in reaching the targeted torque value for optimal preload[6]. The issue with torque drivers is that with repeated use and sterilization, their markings may become difficult to read[6]. This can be especially true with those of the beam type, which also happen to be the most popular[6]. Moreover, when in clinical use, the clinician often swings the beam and visualizes the numbers from an angle rather than directly[6].
One of the most important factors in preventing over-tightening is ensuring that the clinician has adequate training and experience in dental implant placement. Experienced clinicians are more likely to have a feel for the appropriate amount of torque to apply and are better equipped to handle any challenges that may arise during the procedure[8].
Using calibrated instruments, such as torque-controlled ratchets or electronic handpieces, can help ensure accurate and consistent torque application[8]. These instruments provide a visual or audible indication of the amount of torque being applied, allowing the clinician to stay within the recommended range[8].
Prior to implant placement, the clinician should carefully assess the patient's bone density and quality. This assessment can help determine the appropriate torque range for the specific case. In cases of low bone density, for example, a lower torque may be necessary to avoid over-compression[5].
Employing a precise surgical technique is also essential for preventing over-tightening. This includes proper osteotomy preparation, careful implant insertion, and avoiding excessive force or pressure during the procedure[4].
If there is concern that an implant may have been over-tightened, the clinician should closely monitor the implant site for any signs of complications. This includes assessing the surrounding tissue for swelling, redness, or pain, as well as monitoring the implant's stability[5].
In some cases, it may be necessary to intervene to relieve the pressure on the bone. This may involve loosening the implant slightly or adjusting the prosthetic components to reduce stress on the implant-bone interface[1].
Over-tightening a dental implant can have serious consequences, including bone damage, delayed healing, and implant failure. By understanding the risks associated with over-tightening and taking appropriate preventative measures, clinicians can help ensure the long-term success and stability of dental implants. Proper training, calibrated instruments, careful assessment, and precise surgical technique are all essential for avoiding this complication. If over-tightening is suspected, close monitoring and intervention may be necessary to prevent further damage and promote successful osseointegration.
The ideal torque range for dental implant placement is generally between 23 to 35 Ncm (Newton centimeters)[3]. This range allows for optimal primary stability, which is the initial mechanical fixation of the implant in the bone[3].
Over-tightening an implant can lead to excessive compression of the bone around the implant[1]. This compression can disrupt blood flow to the bone cells, leading to necrosis, or bone death[1][2]. Necrosis impairs the bone's ability to integrate with the implant, increasing the risk of implant failure[1].
Clinicians can prevent over-tightening by ensuring they have adequate training and experience, using calibrated instruments, carefully assessing the patient's bone density, and employing a precise surgical technique[8].
Symptoms of a failed dental implant may include excessive swelling and redness of the gums, pain, looseness of the implant, and infection[5].
While retightening the screws is a common practice, it is important to be aware of the potential risks involved[7]. Over-tightening can lead to excessive stress on the implant or the surrounding bone, potentially resulting in implant failure[7]. Instead of simply retightening the screws, a thorough evaluation of other potential causes is crucial to address the issue correctly[7].
[1] https://osadchyclinic.com.ua/en/implant-rejection/
[2] https://www.dentalproductsreport.com/view/3-reasons-why-tight-isnt-right-dental-implants
[3] https://uniqa.dental/articles/torque-or-primary-stability-of-the-implant/
[4] https://www.youtube.com/watch?v=jAlcQe-HgLM
[5] https://www.aksuclinic.com.tr/blog/failed-dental-implant-pictures/
[6] https://www.perioimplantadvisory.com/dental-implants/article/14200668/my-dental-implant-screw-loosened-did-i-miss-something
[7] https://advanceddentistryinstitute.com.au/understanding-implant-crown-screw-loosening/
[8] https://pmc.ncbi.nlm.nih.gov/articles/PMC4705154/
[9] https://www.youtube.com/watch?v=u1WGmF4QwYI
[10] https://www.linkedin.com/pulse/dental-implants-what-insertion-torque-should-you-use-ivan-chicchon
[11] https://journal-jdse.com/Publication/DisplayPDF/26145
[12] https://www.eliteprostheticdentistry.com/smile-gallery/restored-failing-dental-implants-before-after-gallery/
[13] https://www.shutterstock.com/search/fail-implants
[14] https://www.youtube.com/watch?v=cZvTPtFq8uU
[15] https://pubmed.ncbi.nlm.nih.gov/31995037/
[16] https://meridian.allenpress.com/joi/article/46/1/13/425882/The-Relationship-Between-Time-of-Retightening-and
[17] https://decisionsindentistry.com/article/tips-for-successful-implant-screw-joints/
[18] https://burbankdentalimplants.com/all-on-4-dental-implant-problems-and-complications/
[19] https://www.youtube.com/watch?v=C8cBFhzUWNA
