The Effects of High Insertion Torque Versus Low Insertion Torque on Marginal Bone Resorption and Implant Failure Rates: A Systematic Review With Meta-Analyses

Objectives: The aim was to analyze the data about the effects on marginal bone resorption and implant failure rates between implants inserted with high or low insertion torque values. Materials and Methods: A systematic literature search until July 2015 was conducted. Data were summarized qualitatively in descriptive tables and quantitatively by performing random effects meta-analyses of effect sizes (ESs) for bone resorption and bone-to-implant contact (BIC) and relative risks (RRs) for implant failures. Risk of bias assessments were performed using the Cochrane tool for human studies and the SYRCLE's tool for animal studies. Results: Four studies in humans and 6 quasirandomized animal studies were included. A total of 591 implants were evaluated qualitatively: 348 installed with high insertion torque (> 25 Ncm, up to 176 Ncm) and 243 implants inserted with low torque values (<30-35 Ncm). No significant differences were detected for bone resorption (ES, 0.13; 95% confidence interval [CI], -0.12 to 0.38 in human studies; ES predictive interval from 35.03 to 34.50 in animal studies), implant failure (RR, 0.39; 95% CI, 0.01-20.77 in human studies; RR, 2.05; 95% CI, 0.19-21.71 in animal studies), or BIC (ES predictive interval from -3.84 to 5.13 in animal studies). Conclusion: The current review indicated that there is no significant difference in marginal bone resorption and implant failure rate between implants inserted with high or low insertion torque values.