Insertion torque is a TERRIBLE metric for judging primary stability

[@marcosweiss567]

Could you explain a little bit more about this but when we are using low insertion torque (lower than 35Ncm) ?

[@Stanleyinstitute]

The take home message is torque does NOT mean stability. You could have two threads engaging compact bone at the apex of an extraction site with 100 Ncm of torque. (real case) However, only two threads engaging bone would be a high risk for avulsion by the patient with any off-axis loads like the tongue or food. In contrast, you can have a spinner surrounded by bone with zero torque but amazing stability (resistance to movement) because the implant is surrounded by bone. It can be confusing because in dentistry (not in orthopedics) we have been accustom to accepting torque as a proxy for stability.

[@sharifahfaitiha2215]

May i know why the one that’s in bracket are constant?

[@Stanleyinstitute]

Those parameters do not change per case. Therefore they are considered constants and constants can be grouped into one big constant parameter. It is a simplification technique used in engineering. Great question!

[@redefinedentistry4187]

That five thread rule, do all five thread need to be completely surrounded by bone or partially surrounded will also work

[@Stanleyinstitute]

That is a great question. NO, you do not need a full circumferential five threads for stability. If you have two points of contact on five threads then you have bi-socket stabilization and you will have great stability. This often happens with premolars where the implant only engages the medial and distal. On instagram the smileengineer handle has a highlight with lots of real-time planning showing how to use the five thread rule that might be of help.

[@pratimambekar1587]

Sir , you very perfectly & very well ​ explained the BioMechanics of importanceof 5 threads . Thankssir@@Stanleyinstitute

[@drshadykhalifa4839]

Sir i want to ask question please.. I do and happy with your way doing implantology.. i tried alot of ur advised and help me totally… I want to ask about speed of drilling.. what speed and torque for initial drilling program on ur physio dispenser and what rpm and torque for conscience drilling sir Thank you very much

[@Stanleyinstitute]

Thank you for your kind words. When reviewing the literature the best way to keep bone cool is the keep your drill times short. My average drill time is 1.5 per drill. By doing this the bone doesn’t have a chance to heat up. To do that I use a guide and get in and out quickly. Use sharp drills so they are efficient. If you drill quickly you will not need to worry about changing your drill RPM’s depending on the drill diameter. I will make a video to explain this.

[@justinprometheus]

How do you decide whether to place healing abutment during 1st stage surgery?

[@chrisKyle7274]

Many variables, hard and soft tissue considerations here.

[@mohammedalmousaoy7156]

When the torque is above 35

[@Stanleyinstitute]

Torque doesn't equal stability so using dogmatic rules like "35Ncm" is likely resulting in clinical decisions that are less than ideal. Where does the premise that 30-35Ncm of torque measured at insertion is a "good" number for primary stability? It comes from miss understanding of insertion torque recommendations from implant manufactures. Recall years ago the first Branemark implants were CP1 titanium which is the weakest of all titanium grades available. Because they used weak titanium the drivers would plastically deform (break) the implant during insertion if the torque was much above 30Ncm. Therefore, the manufacture recommended that insertion torque NOT exceed 30Ncm for concern over implant fracture NOT because of to much compression on the bone. It is easy to see how this recommendation became misunderstood over time. I do not use insertion torque to determine any of my loading protocols either for All-on-X or for single implants.

[@Stanleyinstitute]

Hey Joseph, I place transmucosal healing abutments on all healed sites, all implants placed into fresh extraction sites unless I use a non-functional immediate provisional or custom healing abutment. The only time I use a healing cap is when primary closure is planned and accomplished. I will be creating a video to explain this concept shortly so stay tuned!

[@justinprometheus]

@@Stanleyinstitute how about isq measurements? They seem to be gold standard for stability.

[@SkyRocketShooter]

It was my understanding that implant can be failed less than 10Ncm torque.. too much stress to the bone can not be good but seem it works. It can though fracture implants.

[@Stanleyinstitute]

It truly can be complicated. What is universally accepted is the implant can not move during healing. Torque is a poor metric to evaluate stability. If you held a coke can really tight with one finger and your thumb it would have less stability than lightly holding it with all five digits? So stability is more challenging to understand. I believe that is why people have created simple guidelines utilizing torque. They simply don’t have an easy way to measure stability and torque is clearly easy to measure.

[@mitchellpersenaire1675]

It’s good to challenge dogma with logic. He makes some good points.

[@Stanleyinstitute]

Thanks Mitchell, I try to bring to light some of the inconsistencies with our current treatment modalities in hopes to start a discussion and possibly make a small advancement for everyone.

[@estebancastellanos7279]

Thank you for making such informative video!!!!

[@Stanleyinstitute]

Glad it was helpful!

[@robertgomez5248]

This is amazing content.

[@Stanleyinstitute]

Thank you. I have some really good stuff coming soon!

[@ayanchakraborty3559]

Pressure necrosis is more evident in bone which is more vascular like cancellous or alveolar bone. Cortical or basal bone since it's less vascular doesn't show pressure necrosis and that's the foundation of cortical implants systems.

[@Stanleyinstitute]

Interesting position. If this premise is true then one would assume that osseodensification would be a catastrophic endeavor? Many doctors use the Versa burs to do that with apparent success. Due to the redundant nature of the blood supply of spongy/trabecular bone avascular necrosis would like be impossible to accomplish.

[@Stanleyinstitute]

Likely*

[@kwanlee7757]

I agree with you but what is your metrics for stability? I think torq is best clinically and measure able. .. eg. Democracy is poor way to govern nationn but we got no alternative. I would love to hear your thoughts and any alternative to torq.

[@bayhappy3992]

Very very interesting. Glad I watched this.

[@Stanleyinstitute]

Glad you enjoyed it!

[@mohammedalmousaoy7156]

What is the minimum acceptable torque? Thank you

[@Mallardman795]

Sounds like zero haha. I’ve had plenty of spinners integrate fine. This seems to explain why

[@chrisKyle7274]

There really is none. I agree, I've had very 'loose' implants integrate well. However, if I had my rathers, I would still shoot for 30-40 Ncm, on a standard diameter implant, when possible. I just sleep better!

[@Stanleyinstitute]

Hey Mallard Man. That is EXACTLY right. Leave those spinners along and you will be surprised at how many integrate!

[@Mallardman795]

@@Stanleyinstitute Now if you have a spinner, what clinical tests do you recommend to evaluate the stability of the implant? In other words, if torque is not an absolute measure of stability, then what is a good clinical measurement you can use?

[@Stanleyinstitute]

alone*

[@ibthibthipad5839]

Thanks for your effort

[@Stanleyinstitute]

It's my pleasure

[@kevinolesik1500]

very clear explanation ...

[@Stanleyinstitute]

Glad you think so!

[@bodnardentalacademy]

nice video, sir

[@Stanleyinstitute]

thank you for watching and your feedback.

[@MdRipon-jc3xy]

😂😂😂😂❤sir

[@Stanleyinstitute]

Cool though huh?