Bone healing at non-submerged implants installed with different insertion torques: a split-mouth histomorphometric randomized controlled trial

Abstract

Objectives: To evaluate histomorphometrically the healing at implants installed with standard or very low insertion torque values MATERIAL AND METHODS: Twelve volunteer patients were recruited, and two screw-shaped titanium devices were installed in the distal segments of the mandible using insertion torque values of either < 10 Ncm or ~ 30 Ncm. The implants were left to heal in a non-submerged fashion. After 8 weeks, biopsies were retrieved, and ground sections were prepared for histological evaluation.

Results: Histological slides from 11 patients were available for (n = 11). The new bone in contact with the implant surface was 39.3 ± 18.5% and 49.4 ± 9.4% at the < 10 and ~ 30 Ncm sites, respectively. Considering the pre-existing old bone, the total mineralized bone was 46.8 ± 22.1% at the < 10 Ncm sites and 57.0 ± 14.1% at the ~ 30 Ncm. No statistically significant differences were found. New bone density and total mineralized bone density were 36.6 ± 8.1% and 53.0 ± 13.5% at the < 10 Ncm sites and 35.9 ± 10.0% and 52.2 ± 16.0% at the ~ 30 Ncm sites, respectively. No statistically significant differences were disclosed.

Conclusion: From the data of the present study, it can be concluded that a trend of higher osseointegration was observed at the ~ 30 Ncm compared to the < 10 Ncm torque group. Nevertheless, it can be concluded that an implant installed with a very low torque may achieve a good integration.

Trial registration: ClinicalTrials.gov NCT04017156; trial retrospectively registered on 12 July 2019.

Keywords: Bone density; Bone-to-implant contact; Dental implants; Histology; Histomorphometry.

Conflict of interest statement

The authors declare that they have no competing of interests.

Figures

Fig. 1

a Customized solid titanium screw-shaped devices used. b Newton-meter to measure the torque

Fig. 2

Two devices installed, one using insertion torque of a) and one of ~ 30 Ncm (b)

Fig. 3

a Trephine used in an eccentric way to reduce the size of the biopsies. b Ground section illustrating the shape of the biopsies

Fig. 4

CONSORT 2010 flow diagram

Fig. 5

a, b Photomicrographs of ground sections of devices installed with old bone (light blue stars). Images originally grabbed at × 100 magnification. Acid fuchsine and toluidine blue stain

Fig. 6

Photomicrographs of ground sections of devices installed with insertion torque (a) < 10 Ncm and (b) ~ 30 Ncm. Note newly formed bone (yellow stars) and pre-existing old bone (light blue stars) and marrow spaces. Image originally taken at × 200 magnification. Acid fuchsine and toluidine blue stain

Fig. 7

a, b Photomicrographs of ground sections of devices installed with insertion torque ~ 30 Ncm. Note newly formed bone (yellow stars) and pre-existing old bone (light blue stars). Originally grabbed at × 100 magnification. Acid fuchsine and toluidine blue stain