Torquing (with torque wrench) and pressure necrosis?

Most of the time, the implants I placed reach 30-35Ncm about 2mm supracrestal in D2-3 bone. In order to get the implants subcrestally, I have to torque it down with a torque wrench (with a HIGH torque) and reverse it to release the pressure, and repeat 2-3 times to get the implant placed at the desired level. The final torque is 35Ncm. But I was just wondering if placing implants in this way tends to cause pressure necrosis. Does inserting implants in this way densify or expand the surrounding boneļ¼Ÿ

Periodrill comments:

It does not.

Dr Peter Hunt comments:

It all depends on whether the stability is achieved in cortical or cancellous bone. If the implant comes hard up against cortical bone then the blood flow to that region can be compromised, leading to necrosis.

In general, high initial stability is over stressed, the most important aspect is to place an implant in a mode where regeneration and OsseoIntegration develops rapidly.

Dennis Flanagan DDS MSc comments:

Some work shows that an insertion torque to 75NCM is not detrimental

Matt Helm DDS comments:

It's true. I know firsthand.

Raul Mena comments:

Personally I like 32 Ncm or none. I obtain Excellent results. By placing them with this Technic you avoid obliterating the bone vascularity. No blood no vital tissue no osseointegration,

Matt Helm DDS comments:

Reversing to alleviate the pressure does solve the problem, specially if you repeat it and do not overtorque. I've done it myself a few times and never had a problem. The implants are fine, some even 15 years later. However, I do think that initial insertion torque as a pure number is over-rated and over-emphasized. While it is certainly an important indicator, that is not what we should be chasing as an absolute condition to success. Position, angulation, and a good, clean surgical technique that ensures placement in healthy bone and an adequate blood supply, along with allowing sufficient healing time are paramount. Of course, ultimately, proper prosthetic restoration is key.