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Effect of implant design on primary stability

using torque-time curves in artificial bone

Article · August 2015

DOI: 10.1186/s40729-015-0024-0

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Yamaguchi et al. International Journal of Implant Dentistry (2015) 1:21
DOI 10.1186/s40729-015-0024-0

RESEARCH Open Access

Effect of implant design on primary stability

using torque-time curves in artificial bone
Yoko Yamaguchi1*, Makoto Shiota2, Motohiro Munakata3, Shohei Kasugai2 and Masahiko Ozeki1

Abstract
Background: Primary stability following implant placement is essential for osseointegration and is affected by both
implant design and bone density. The aim of this study was to compare the relationships between torque-time
curves and implant designs in a poor bone quality model.
Methods: Nine implant designs, with five implants in each category, were compared. A total of 90 implants
(Straumann: Standard RN, Bone Level RC, Tapered Effect RN; Nobel Biocare: Brånemark MKIII, MKIV) were placed in
type IV artificial bone. Torque-time curves of insertion and removal were recorded at the rate of 1000 samples/s by
a torque analyzer.
Results: The torque-time curves were divided into initial, parallel, tapered, and platform areas. The mean torque rise
rate of the parallel area was smallest at 0.36 N · cm/s, with a significant difference from those of the other areas
(p < 0.05). Values of 2.14, 2.33, and 2.65 N · cm/s were obtained for the initial, tapered, and platform areas,
respectively. The removal torque for six of the implant designs (Bone Level RC 8, 10, and 12 mm; Tapered Effect RN
10 mm; Brånemark MKIII 10 mm, MKIV 10 mm) was significantly smaller than the corresponding insertion torque
(p < 0.05). However, the removal torque for ST6, 8, and 10 was almost the same as or slightly greater than the
corresponding insertion torque.
Conclusions: The insertion torque-time curves and design features of the implants were accurately transferred.
Increasing implant taper angle appeared to increase the torque rate. Torque was mainly generated from the
superior surface to the valley of the thread and the inferior and axial surfaces of the platform, while the inferior and
axial surfaces of the thread did not significantly affect torque generation.
Keywords: Primary stability; Implant design; Bone density; Torque-time curve; Insertion torque; Removal torque

Background entire implant [6]. Among implant designs, it has been

Primary stability following implant placement is an described that good primary stability can be achieved for
essential condition for osseointegration. The primary long and thick implants [7–10] with a small pitch [11]
stability is affected by the implant design, including and a taper [6, 12–18], but the cited reports only evalu-
surface-modifying or implant cavity-forming techniques, ated primary stability for the entire implant. An implant
as well as by the bone quantity and bone density of the has characteristic shapes such as parallel, tapered, and
patient [1–3]. In recent years, the interest of implant platform areas, and the overall design is constructed by
manufacturers and clinicians has shifted to the acquisi- placing these areas together. However, there have been
tion of good fixation, especially for incurable cases in no reports of studies that quantitatively measured and
which the density of cancellous bone, such as the max- evaluated individual designs involved in primary stability.
illa molar part, is low and the cortical bone is thin [4, 5], It has been reported that quantitative techniques are ne-
for which the effects of surface-modifying techniques are cessary to enable the criteria for successful endosseous im-
low and focus has been changing to the design of the plants to be more clearly defined [17]. Periotest [19, 20],
resonant vibration frequency analysis [21], implant torque
* Correspondence: blacklab87@gmail.com value [22], and removal torque value [23] are used as
1
Department of Implant Dentistry, Showa University School of Dentistry,
2-1-1 Kitasenzoku Ota-ku, Tokyo 145-8515, Japan quantitative primary stability evaluations. However, in the
Full list of author information is available at the end of the article

© 2015 Yamaguchi et al. Open Access This article is distributed under the terms of the Creative Commons Attribution 4.0
International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and
reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to
the Creative Commons license, and indicate if changes were made.
Yamaguchi et al. International Journal of Implant Dentistry (2015) 1:21 Page 2 of 7

periotest and resonant vibration frequency analysis, only value. In addition, the removal torque value (RT) was
general numerical values can be obtained from an implant obtained from the removal torque curve when the im-
and it is impossible to perform analyses for individual de- plant was reversed immediately after insertion.
signs. Furthermore, regarding the implant torque value
and removal torque value, analyses for individual designs Measurement of the rate of torque rise
are impossible as long as only the maximum torque value The average torque rise rate (N · cm/s) in each region
is used in the conventional methods. Therefore, in this was obtained from the point that the origin and torque
study, for the purpose of measuring the effects of individ- rose immediately after implantation, with both ends of
ual implant designs quantitatively, simulation experiments the region indicating lines, both ends of the region indi-
with artificial bone were performed. cating a quadratic function, and the torque values and
implant time of both ends indicating a logarithmic func-
Methods tion becoming gradual on the implant torque curve, and
Implants mean values and SD were calculated.
The type of implant used for the experiments and the
characteristics of its design are shown in Table 1 and Statistical analysis
Fig. 1, respectively. Figure 1 shows that the implant is It was confirmed that the measurement results for the
compressed longitudinally to one third. The outer sur- insertion and removal torque values of each implant
face of the implant is indicated with a solid line, and the were normally distributed, and their significant differ-
inner surface of the implant is indicated with a dotted ences were examined by Student’s t test and the Tukey–
line. Kramer method (JMP software; SAS Institute Japan,
Tokyo, Japan). The significance level was set at p = 0.05.
Preparation of an implant socket in artificial bone
For artificial bone, rigid polyurethane foam (Solid Rigid Results
Polyurethane Foam 20 pcf; Sawbones; Pacific Research Insertion torque
Laboratories Inc., USA) measuring 18 × 4 × 13 cm and ap- The insertion torque curve was divided into four re-
proaching the maxilla molar part bone density (0.32 g/cc) gions. The first was the region where the torque rose
and physical properties (compressive strength, 8.4 MPa; suddenly immediately after insertion, which was seen in
tensile strength, 5.6 MPa; shear strength, 4.3 MPa; coeffi- all implant bodies (shown as ① in the figure, and herein-
cient of elasticity, 284 GPa) [24] was employed. An im- after called the initial area). The second was the region
plant socket was formed by making an interval of more where the torque rose linearly with a moderate gradient,
than 2 cm, while avoiding axis wobbling as much as pos- which was seen in all implant bodies except for Bråne-
sible, with a drill press (ASD-360; Ashina, Hiroshima, mark MKIV (MK4) (shown as ② in the figure, and here-
Japan) in the artificial bone. inafter called the parallel area). The third was the region
where torque rose suddenly, which was seen in Bone
Measurement of torque-time curves Level RC (BL), Tapered Effect RN (TE), and MK (shown
For measurement of torque-time curves, a torque meas- as ③ in the figure, and hereinafter called the tapered
urement system capable of high-speed sampling at 1 area). The fourth was the region where the torque
sample/ms (PC torque analyzer TRQ-5DRU; Vectrix, reached a critical point, rose suddenly, and then rose
Tokyo, Japan) was used. The rotational speed at the time gently, which was seen in Brånemark MKIII (MK3) and
of insertion was 15 rpm, the load was 500 g, and the MK4 (shown as ④ in the figure, and hereinafter called
maximum torque value indicated in the torque-time the tapered area).
curve (and following implant torque curve) when insert- Regarding the Standard RN (ST), the axial surface and
ing the implant (Osseoset 200; Nobel Biocare Japan, lateral surface were parallel, while for ST6, 8, and 10,
Tokyo, Japan) was assumed as the insertion torque only the length was different. The insertion torque curve
of the ST3 class shown in Fig. 2a resembled closely, and
Table 1 The type of the implant used for experiment
moderate gradient lines were presented after the initial
System Length Pitch Lead Code Manufacturer area in which the torque rose immediately after implant-
(mm) (mm) (mm) ation (parallel area). The length and insertion torque
Standard RN 6, 8, 10 1.2 1.2 ST Straumann values of the parallel area varied as the length of the im-
Bone Level RC 8, 10, 12 0.8 0.8 BL Straumann plant varied among 6, 8, and 10 mm.
Tapered Effect RN 10 0.8 0.8 TE Straumann The torque curve for BL3 in Fig. 3a presented a sud-
Brånemark MKIII 10 0.6 1.2 MK3 Nobel Biocare
den rise in torque on a quadratic function in the initial
area immediately after insertion and a subsequent paral-
Brånemark MKIV 10 0.6 1.2 MK4 Nobel Biocare
lel area (tapered area). As the length of the implant
Yamaguchi et al. International Journal of Implant Dentistry (2015) 1:21 Page 3 of 7

Fig. 1 Compressed longitudinally to one third for characteristics of implant design. ST Straumann standard implant, MK3 Nobel Biocare MKIII,
BL Straumann bone level implant, TE Straumann tapered effect implant, MK4 Nobel Biocare MKIV. Outer surface of implant (solid line). Inner
surface of implant (dotted line)

varied among 8, 10, and 12 mm, only the length of the was parallel, similar to ST, and had a platform, similar to
parallel area changed, and the initial area and tapered MK4, and a platform area was seen in the last part of
area had almost the same form. The lateral surface for the torque curve. In MK3, the platform area followed
BL was entirely parallel, while the axial surface had a the initial area and parallel area, although it presented a
taper only in the cervical region and the thread of the final torque value of 4.3 N · cm in the parallel area and
area was decreased in height. The torque curve for the then rose further to 10.7 N · cm in the platform area.
BL3 class in Fig. 3a showed a rapid rise in torque in the
form of a tapered area in the initial area immediately Removal torque
after implantation and in a subsequent parallel area. In the removal torque curve, the characteristics of the
When the length of the implant varied among 8, 10, and implant design were not clearly recognized, compared
12 mm, only the length of the parallel area changed, and with the implant torque curve. In all implants, the
the initial area and tapered area had almost the same torque rose suddenly immediately after removal was
form. For the TE, the lower part of the implant was par- started and reached a peak value. The changes in torque
allel and the lateral surface and axial surface had the from the peak value were classified into two types. For
same taper in the cervical region. TE10 in Fig. 4a ST shown in Fig. 2b, the torque fell gently from the peak
showed a torque curve with a similar form to BL10 in value. For BL, TE, MK3, and MK4 in Figs. 3b, 4b, and
Fig. 3 and had three kinds of areas. The torque curves 5b, a sudden fall in torque was seen immediately after
for MK3 and MK4 in Fig. 4a had an area in which the the peak value, and it then fell gently. Table 2 shows the
torque finally rose suddenly after reaching its critical maximal values for insertion torque value (IT) and RT
point and became moderate. This was distinguished obtained from the torque curves and the p values ob-
from the tapered areas of BL and TE and assumed to be tained by significance tests for RT and IT. The RT for six
a platform area. MK4 had a gentle taper on the entire kinds of implants (BL8, 10, 12, TE10, MK3, MK4) was
axial surface and platform. The platform area, shown in smaller than the corresponding IT, with statistical sig-
④, was seen at the end of the torque curve in Fig. 5a, nificance (p < 0.05), while the RT for ST6, 8, and 10 was
and its torque value was the maximum value among the almost the same as or slightly greater than the corre-
nine kinds evaluated in this study. In past reports, MK3 sponding IT.

Fig. 2 Torque-time curves of the ST. a Insertion torque. b Removal torque

Yamaguchi et al. International Journal of Implant Dentistry (2015) 1:21 Page 4 of 7

Fig. 3 Torque-time curves of the BL. a Insertion torque. b Removal torque

Torque rise rate insertion torque, angular momentum, and total insertion
Table 3 shows the average torque rise obtained from the energy by torque curves, although quantitative analyses
torque curve according to areas. The mean torque rise on whether torque curves were correlated with implant
rate of the parallel area was the smallest at 0.36 N · cm/s designs were not conducted. Furthermore, most conven-
and differed significantly from those of the other areas tional studies on torque have focused on measurement
(p < 0.05). Specifically, the rates were 2.14, 2.33, and [28–31] of the maximum torque value and/or RT at the
2.65 N · cm/s for the initial area, tapered area, and plat- time of IT or the relationship between the RFA value and
form area, respectively, and greater than those of the IT and/or RT [6, 13, 16, 18, 32]. The present study was
parallel area by 6–7 times, although significant differ- not limited to measurements of IT and RT, as the charac-
ences were not recognized among the mean values of teristics of the torque curves were divided into four areas
these three areas. designated as the initial, parallel, tapered, and platform
areas, and quantitative analyses were performed for each
Discussion area. For the initial area, a rapid rise in torque occurring
Insertion torque curve immediately after insertion for 1–2 s was observed, and
In 2000, O’Sullivan reported torque curves for a pros- torque value rises of 1.43–2.26 N · cm were also recog-
thetic implant for the first time, and evaluated the char- nized. This reflects torque generated by the implant
acteristics of the tapered type by torque curves obtained placed at the predetermined position on the prepared hole
by inserting five kinds of implants into the maxillary rotating and rubbing with the artificial bone with the load
bone of unembalmed human cadavers. In a subsequent of 500 g, and it is presumed that the rapid rise in the ini-
review, Meredith [25] cited six kinds of torque curves tial area was a phenomenon when the thread ridge was
when the final osteotomy diameter was changed and de- inserted into the artificial bone. This indicates that the
scribed that a torque curve rose more markedly with a friction at the time of rotating and pressing is greater than
thinner implant cavity. In 2011, Kim et al. [26] compared that at the time of rotating and cutting the bones with a
a case with a self-tapping blade and a case without a tap and is a reasonable result. In the parallel area, the
self-tapping blade using their torque curves with artificial torque curve was a line with a moderate gradient, and the
bone. In 2012, Park et al. [27] obtained the maximum torque rise rate obtained from the gradient of the line was

Fig. 4 Torque-time curves of the TE. a Insertion torque. b Removal torque

Yamaguchi et al. International Journal of Implant Dentistry (2015) 1:21 Page 5 of 7

Fig. 5 Torque-time curves of the MK3 and MK4. a Insertion torque. b Removal torque

0.36 N · cm/s. From this, it is estimated that the torque in- Removal torque curve
crease when one revolution is added to the parallel thread There have been reports on the removal torque curve of
is about 1.44 N · cm. The preceding thread goes forward a prosthetic implant. Although the removal torque
and spreads out the bones consistently, and the following curves measured in the present study had similar shapes
thread of the same size does not cause new torque at the to one another, they were divided into two groups upon
time of plastic deformation, and it is therefore presumed detailed observation, comprising a group of ST with par-
that the torque rise in the parallel area is moderate. In the allel only, and a group of BL, TE, MK3, and MK4 having
tapered area, the torque curve presented a quadratic curve tapers and platforms. Since the thread contacts the artifi-
steadily, the torque rise rate was 2.33 N · cm/s, and the cial bone sequentially at the time of insertion, the torque
torque increase when one revolution was added was as curves showed the characteristics of each area. At the time
great as 9.32 N · cm. From this, it is supposed that an in- of removal, since all threads come in contact with the arti-
crease in the tapered thread is an effective method to in- ficial bone at first, the torque curve did not present the
crease the torque efficiently. In the tapered area, the characteristics of the design until it reached the peak
diameters of the following threads continued to increase value. However, it is estimated that when the thread be-
consistently, plastic deformation was caused in all threads gins to move subsequently, the difference in design of
in the tapered area, and a torque curve in which the each area appeared in the torque curve. It seems that the
torque continued to increase was produced as a result. It change in torque after reaching the peak value at the time
is supposed that the first rapid rise in the platform area of removal is important information for predicting the in-
was observed when the platform bottom compressed the fluence of the change in primary stability occurring
artificial bone and that stress relaxation of the artificial through instant load and the early load on secondary sta-
bone made it more moderate subsequently. The torque bility. The torque value that instantly decreased with a ta-
rise rate by the platform was 2.65 N · cm/s, which was pered implant was as small as 4–7 N · cm, and it is
greater than that of the tapered area. necessary to study this further in the future.

Table 2 Insertion torque value and removal torque value Table 3 Torque rise rate of the each area (N · cm/s)
Code Insertion torque Removal torque Effective thread length (ETL) Initial area Parallel area Tapered area Platform area
(N · cm) (N · cm) (×π mm) ST6 1.42 ± 0.43 0.31 ± 0.14 – –
ST6 6.19 ± 0.716 5.95 ± 0.718 11.53 ST8 3.57 ± 1.62 0.35 ± 0.09 – –
ST8 8.06 ± 1.038 9.09 ± 1.093 15.11 ST10 2.49 ± 0.81 0.45 ± 0.05 – –
ST10 13.13 ± 1.763 12.37 ± 1.746 21.48 BL8 2.16 ± 0.21 0.50 ± 0.08 2.32 ± 0.52 –
BL8 17.67 ± 1.290 16.67 ± 2.140 20.88 BL10 1.96 ± 0.49 0.35+0.04 2.45+0.23 –
BL10 23.56 ± 1.628 21.99 ± 1.530 31.00 BL12 1.82 ± 0.27 0.33 ± 0.02 3.41 ± 0.64 –
BL12 26.66 ± 3.897 24.40 ± 2.298 39.96 TE10 2.37 ± 0.42 0.44 ± 0.05 2.30 ± 0.29 –
TE10 25.17 ± 2.374 23.76 ± 2.027 31.11 MK3 2.16 ± 0.28 0.15 ± 0.02 – 3.33 ± 0.85
MK3 16.03 ± 0.516 10.30 ± 0.708 39.38 MK4 2.00 ± 0.00 – 1.30 ± 0.02 2.44 ± 0.09
MK4 39.35 ± 0.494 34.31 ± 0502 54.81 Average 2.22 ± 0.60 0.36 ± 0.18 2.36 ± 0.75 2.89 ± 0.63
±:SD ±:SD
Yamaguchi et al. International Journal of Implant Dentistry (2015) 1:21 Page 6 of 7

Comparison between IT and RT the parallel thread area, a quadratic curve-like curve in
The purpose of measuring and evaluating RT in the the tapered area, and a hyperbola-like curve in the plat-
present study was to clarify whether the implant stability form area. The torque rise rate was 2.14 N · cm/s for the
evaluated by IT can be guaranteed even immediately initial area, 0.36 for the parallel area, 2.33 for the tapered
after insertion. In this study, RT was smaller than IT in area, and 2.65 for the platform area. The torque-
the implants having tapered and/or platform areas and a duration curves at the time of removal were classified
significant difference was recognized, while in the design into tapered implants with the peak magnitude as the
with only a parallel area, no significant difference was maximum torque value and straight implants with a
seen between IT and RT or RT was slightly greater than maximum torque value greater than the peak magnitude.
IT. Previous studies that measured both IT and RT in- The RT of the implants having tapered or platform areas
clude those using artificial bone [19, 33], human bone was significantly smaller than the corresponding IT,
[6, 16, 34], and animal bones [35, 36]. Among such stud- while the RT of the straight implants was the same as or
ies, IT and RT were small in those using artificial bone, slightly greater than the corresponding IT.
and RT was smaller than IT. Therefore, using IT to as-
Abbreviations
sess the primary stability of an implant revealed the need BL: Bone Level RC; IT: insertion torque value; MK3: Brånemark MKIII;
for certain adjustments. MK4: Brånemark MKIV; RT: removal torque value; ST: Standard RN; TE: Tapered
Effect RN.
Influence of cortical bone
Competing interests
The reason why a simulation test for only cancellous Dr. Yamaguchi reports grants from The Ministry of Education, Culture, Sports,
bone without cortical bone was performed in the present Science and Technology, JSPS KAKENHI Grant Number 217919, non-financial
study has already been described. It was reported that support from Straumann LLC, during the conduct of the study. The other
authors declare that they have no competing interests.
bone density and the ratio of cortical bone and cancel-
lous bone have influence on the primary stability of an Authors’ contributions
implant and that higher primary stability is achieved YY participated in the sequence alignment concept/design, data collection,
and data analysis and drafted the manuscript. MS conceived of the study,
with thread, even at the slightest level, binding to cor- participated in its design and coordination, and helped draft the manuscript.
tical bone rather than being surrounded by only cancel- MM participated in the data collection and performed the statistical analysis.
lous bones [32]. Therefore, it is expected that torque will SK participated in the design of the study. MO participated in the critical
revision of the article. All authors read and approved the final manuscript.
rise at the end of the torque curve in the cortical bone
region and that the torque will further grow by a syner- Acknowledgements
gistic effect with factors that increase the torque, such as The authors thank the Vectrix Corporation for the technical knowledge of
the torque analyzer and Straumann LLC for donating the implants used in
a taper or platform of an implant. In the simulation ex- this research. This study was supported by JSPS KAKENHI Grant Number
periments in this study, quantitative measurements were 217919, The Ministry of Education, Culture, Sports, Science and Technology.
successfully performed by extracting only the effects of
Author details
implant designs and by using a uniform pseudo bone 1
Department of Implant Dentistry, Showa University School of Dentistry,
without cortical bones. Sufficient torque is needed for 2-1-1 Kitasenzoku Ota-ku, Tokyo 145-8515, Japan. 2Oral Implantology and
primary stability of an implant, although the risk that ex- Regenerative Dental Medicine, Department of Masticatory Function
Rehabilitation, Division of Oral Health Sciences, Graduate School, Tokyo
cessive compressive force acts on the bone to cause Medical and Dental University, 1-5-45 Yushima, Bunkyo-ku, Tokyo 113-8510,
bone resorption and further bone necrosis has been Japan. 3Oral Implantology Department of Prosthodontic Dentistry for
pointed out [37, 38]. To avoid such a situation, it is ne- Function of TMJ and Occlusion, Kanagawa Dental University, 82, Inaokachou,
Yokosuka-shi, Kanagawa 238-8580, Japan.
cessary to find a balance between local bone resorption
and the torque, and Meredith [25] recommended inser- Received: 9 December 2014 Accepted: 28 July 2015
tion torque values of 25–30 N · cm. The torque value
and torque rising rate according to the design of implant
References
bodies obtained in the present study enabled estimation 1. Friberg B, Sennerby L, Roos J, Johansson P, Strid CG, Lekholm U. Evaluation
of the part of bones generating retention and identifica- of bone density using cutting resistance measurements and
tion of the part giving compressive force to bones. This microradiography. An in vitro study in pig ribs. Clin Oral Implants Res.
1995;6:164–71.
will allow us to clarify the relationships among the de- 2. Chiapasco M, Gatti C, Rossi E, Haeflige W, Markwaldel TH. Implant-retained
sign of an implant, the value of the torque generated by mandibular overdentures with immediate loading: a retrospective
the implant, and the compressive force to the bones. multicenter study on 226 consecutive cases. Clin Oral Implants Res.
1997;8:48–57.
3. Javed F, Romanos GE. The role of primary stability for successful immediate
Conclusions loading of dental implants. A literature review. J Dent. 2010;38:612–20.
In the torque-duration curve at the time of insertion, the 4. Lekholm U, Zarb GA. Patient Selection and Preparation. In: Brånemark P-I,
Zarb GA, Albrektsson T, editors. Tissue integrated prostheses:
characteristics of the implant design are well shown. It is osseointegration in clinical dentistry. Chicago: Quintessence Publishing Co.
presented as a straight line with a moderate gradient in Inc; 1985. p. 199–209.
Yamaguchi et al. International Journal of Implant Dentistry (2015) 1:21 Page 7 of 7

5. Devlin H, Horner K, Ledgerton D. A comparison of maxillary and mandibular 30. Simon H, Caputo AA. Removal torque of immediately loaded transitional
bone mineral densities. J Prosthet Dent. 1998;79:323–7. endosseous implants in human subjects. Int J Oral Maxillofac Implants.
6. O’Sullivan D, Sennerby L, Meredith N. Measurements comparing the initial 2002;17:839–45.
stability of five designs of dental implants: a human cadaver study. Clin 31. Marin C, Granato R, Suzuki M, Gil JN, Piattelli A, Coelho G. Removal torque
Implant Dent Relat Res. 2000;2:85–92. and histomorphometric evaluation of bioceramic grit-blasted/acid-etched
7. Ochi S, Morris HF, Winkler S. The influence of implant type, material, and dual acid-etched implant surfaces: an experimental study in dogs. J
coating, diameter, and length on periotest values at second-stage surgery: Periodontol. 2008;79:1942–9.
DICRG interim report no.4. Dental Implant Clinical Research Group. Implant 32. Ahn SJ, Leesungbok R, Lee SW, Heo YK, Kang KL. Differences in implant
Dent. 1994;3:159–62. stability associated with various methods of preparation of the implant bed:
8. Winkler S, Morris HF, Ochi S. Implant survival to 36 months as related to an in vitro study. J Prosthetic Dent. 2012;107:366–72.
length and diameter. Ann Periodontol. 2000;5:22–31. 33. Blickford JH. An introduction to the design and behavior of bolted joints.
9. Steigenga JT, Al-Shammari KF, Nociti FH, Misch CE, Wang HL. Dental New York: Marcel Dekker Inc; 1995. p. 213.
implant design and its relationship to long-term implant success. Implant 34. Shalabi MM, Wolke JGC, Jansen JA. The effects of implant surface roughness
Dent. 2003;12:306–17. and surgical technique on implant fixation in an in vitro model. Clin Oral
10. Baggi L, Cappelloni I, Di Girolamo M, Maceri F, Vairo G. The influence of Implants Res. 2006;17:172–8.
implant diameter and length on stress distribution of osseointegrated 35. Sakoh J, Wahlmann U, Stender E, Nat R, Al-Nawas B, Wagner W. Primary
implants related to crestal bone geometry: a three-dimensional finite stability of a conical implant and a hybrid, cylindric screw-type implant
element analysis. J Prosthet Dent. 2008;6:422–31. in vitro. Int J Oral Maxillofac Implants. 2006;21:560–6.
11. Orsini E, Giavaresi G, Trire A, Ottani V, Salgarello S. Dental implant thread 36. Tabassum A, Meijer GJ, Wolke JGC, Jansen JA. Influence of the surgical
pitch and its influence on the osseointegration process: an in vivo technique and surface roughness on the primary stability of an implant in
comparison study. Int J Maxillofac Implants. 2010;2:383–92. artificial bone with a density equivalent to maxillary bone: a laboratory
12. Romanos GE, Ciornei G, Jucan A, Malmstrom H, Gupta B. In vitro assessment study. Clin Oral Implants Res. 2009;20:327–32.
of primary stability of Straumann implant designs. Clin Implant Dent Relat 37. Atsumi M, Park SH, Wang HL. Methods used to assess implant stability:
Res. 2012;16:89–95. current status. Int J Oral Maxillofac Implants. 2007;22:743–54.
13. Toyoshima T, Wagner W, Klein MO, Stender E, Wieland M, Al-Nawas B. 38. Duyck J, Renold HJ, Van Oosterwyck H, Naert I, Vander Sloten J, Ellingsen JE.
Primary stability of a hybrid self-tapping implant compared to a cylindrical The influence of static and dynamic loading on marginal bone reactions
non-self-tapping implant with respect to drilling protocols in an ex vivo around osseointegrated implants: an animal experimental study. Clin Oral
model. Clin Implant Dent Relat Res. 2011;13:71–8. Implants Res. 2001;12:207–18.
14. O’Sullivan D, Sennerby L, Jagger D, Meredith N. A comparison of two
methods of enhancing implant primary stability. Clin Implant Dent Relat
Res. 2004;6:48–57.
15. O’Sullivan D, Sennerby L, Meredith M. Influence of implant taper on the
primary and secondary stability of osseointegrated titanium implants. Clin
Oral Implants Res. 2004;15:474–80.
16. Akkocaoglu M, Uysal S, Tekdemir I, Akca K, Cehreli MC. Implant design and
intraosseous stability of immediately placed implants: a human cadaver
study. Clin Oral Impl Res. 2005;16:202–9.
17. Chong L, Khocht A, Suzuki JB, Gaughan J. Effect of implant design on initial
stability of tapered implants. J Oral Implantol. 2009;3:130–5.
18. Meredith N. Assessment of implant stability as a prognostic determinant. Int
J Prosthodont. 1998;11:491–501.
19. Olive J, Aparicio C. Periotest method as a measure of osseointegrated oral
implant stability. Int J Oral Maxillofac Implants. 1990;5:390–400.
20. Teerlinck J, Quirynen M, Darius P, van Steenberghe D. Periotest: an objective
clinical diagnosis of bone apposition toward implants. Int J Oral Maxillofac
Implants. 1991;6:55–61.
21. Meredith N, Alleyne D, Cawley P. Quantitative determination of the stability
of the implant-tissue interface using resonance frequency analysis. Clin Oral
Implants Res. 1996;7:261–7.
22. Johansson P, Strid K. Assessment of bone quality from cutting resistance
during implant surgery. J Prothodont. 1998;9:491–501.
23. Roberts WE, Smith RK, Zilberman Y, Mozsary PG, Smith RS. Osseous
adaptation to continuous loading of rigid endosseous implants. Am J
Orthod. 1984;86:95–111.
24. Doe J. Sawbone block 20 PCF. 2014. www.sawbones.com.
Accessed 8 Dec 2014.
25. Meredith N. A review of implant design, geometry and placement. Appl
Osseointegrantion Res. 2008;6:8–12.
26. Kim DR, Lim YJ, Kim MJ, Kwon HB, Kim SH. Self-cutting blades and their
Submit your manuscript to a
influence on primary stability of tapered dental implants in a simulated low- journal and benefit from:
density bone model: a laboratory study. Oral Surg Oral Med Oral Pathol Oral
Radiol Endo. 2011;112:573–80. 7 Convenient online submission
27. Park KJ, Kwon JY, Kim SK, Heo SJ, Koak JY, Lee JH, et al. The relationship 7 Rigorous peer review
between implant stability quotient values and implant insertion variables: a 7 Immediate publication on acceptance
clinical study. J Oral Rehabil. 2012;39:151–9. 7 Open access: articles freely available online
28. Ueda M, Matsuki M, Jacobsson M, Tjellstrom A. Relationship between
7 High visibility within the field
insertion torque and removal torque analyzed in fresh temporal bone. Int J
Oral Maxillofac Implants. 1991;6:442–7. 7 Retaining the copyright to your article
29. Niimi A, Ozeki K, Ueda M, Nakayama B. A comparative study of removal
torque of endosseous implants in the fibula, iliac crest and scapula of
Submit your next manuscript at 7 springeropen.com
cadavers: preliminary report. Clin Oral Implants Res. 1997;8:286–9.