Inserting Implants: Use Particular Speed or Torque Value?
Dr. L. asks:
I am a beginner in placing dental implants. I am not clear about what I am supposed to use as a guide when I insert the implants into a healed edentulous site. Am I supposed to use a particular speed – like 30 rpm – or am I supposed to use a torque value like 45 Ncm? I have heard both guidelines in lectures and I want to know the best procedure that will produce long term success. One expert says one thing and another expert says something else. My level of training and experience is too low to know who to follow. What is the correct method?
6 Comments on Inserting Implants: Use Particular Speed or Torque Value?
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Charles Schlesinger, DDS
8/17/2009
You need to see what the implant manufacturer recommends for the sytem you are using. As far as speed- it should be around 20-25rpm in order to not overheat and/or strip the osteotomy. Regarding torque- we like to see 35-40n/cm. Sometimes it takes a bit more to seat the ompant, but you do not want to exceed that by much. Some studies have stated 60n/cm upper limits to avoid pressure necrosis.
Astronaft
8/17/2009
These are REALLY basic questions.
Implant placement should be restoration driven, minimally traumatic and yield lasting results. So look at the adjucent teeth for direction, or use guide. Cool well by copious irrigation. 20 rpm for insertion with irrigation, or if manual - slower and with breaks. 35-45n/cm would be ideal, if more try to unscrew couple of turns and screw again -this usually decreses torque value by 5n/cm.
Frank Serio
8/18/2009
Why not place the implant by hand? Time really is not a major issue and you can feel the implant in the osteotomy site. Also, it is very difficult to strip the osteotomy by hand unless you have very soft bone, and then you should probably not be using motorized placement anyway.
Melvin
8/18/2009
I have placed several implants in very soft bone...able to drive the implant with finger rotations. I usually allow 6 months of healing for those. If I have denser bone and the torque value is 30-35 N-cm or greater, then the healing time is shorter..maybe 2-3 months.
If you are in very very dense bone, use a tap to place the screw threads in the bone and then place the implant, meeting great resistance will change my technique in 1/3 - 1/2 turn of the torque wrench and wait 15-20 seconds to allow bone expansion and continue until the implant is seated to the planned depth.
A.Romano dr. med.dr .dent
9/5/2009
i put my implants only by hand with different keys; so you will not have problems with torque or heating and you will have the best sensibility in yor hands.
Richard Hughes DDS, FAAID
9/6/2009
Dr. A. Romano, I agree with you. There is no substitute for the tactile senses. You are most correct, there is no heat. I use to place alot of Stryker and now Bicon Implants. I changed to mostly using MIS 7 and AB dental implants when a root form is required. I still use the Bicon Implant in selected situations.
