Journal of Prosthetic Dentistry

Accuracy of mechanical torque-limiting devices for implant screw tightening: A systematic review and meta-analysis

Published:September 20, 2022DOI:


      Statement of problem

      A consensus is lacking on the accuracy of torque value on different types of mechanical torque-limiting devices.


      The purpose of this systematic review and meta-analysis was to determine the accuracy of unused mechanical torque-limiting devices.

      Material and methods

      Electronic searches were conducted until October 2021 in 6 electronic databases. Relevant articles were manually screened in 5 journals from January 2000 to October 2021. Two reviewers screened titles, abstracts, and full texts and extracted the data independently. A meta-analysis was conducted to evaluate the weighted mean difference in torque value deviation from target torque between spring-style and friction-style devices as a primary outcome. Deviations of output torque value from target value in spring-style or friction-style devices were also analyzed as a secondary outcome.


      A total of 11 595 articles were identified, and 16 articles were included for final statistical analysis. Meta-analysis of the included articles showed that torque value deviation in the spring-style was significantly lower than in the friction-style devices (-0.99 Ncm, 95% confidence interval [CI]: [-1.89, -0.09], P=.030). Deviations of output torque value from target value was -0.54 Ncm in the spring-style group (CI: [-1.23, 0.15], P=.122) and -0.18 Ncm in the friction-style group (95% CI: [-1.40, 1.04], P=.770). Meta-regression analysis indicated that target value was significantly associated with the mean deviation from target value only in the spring-style group. High heterogeneity was found, suggesting more studies with standardized research design are required.


      Both spring- and friction-style mechanical torque-limiting devices can produce relatively accurate torque values; however, unused spring-type devices tend to have lower deviation from target torque value than unused friction-type devices.
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        • Gallucci G.O.
        • Benic G.I.
        • Eckert S.E.
        • et al.
        Consensus statements and clinical recommendations for implant loading protocols.
        Int J Oral Maxillofac Implants. 2014; 29 Suppl: 287-290
        • Papaspyridakos P.
        • Chen C.-J.
        • Chuang S.-K.
        • Weber H.-P.
        • Gallucci G.O.
        A systematic review of biologic and technical complications with fixed implant rehabilitations for edentulous patients.
        Int J Oral Maxillofac Implants. 2012; 27: 102-110
        • Jemt T.
        Failures and complications in 391 consecutively inserted fixed prostheses supported by Brånemark implants in edentulous jaws: a study of treatment from the time of prosthesis placement to the first annual checkup.
        Int J Oral Maxillofac Implants. 1991; 6: 270-276
        • Naert I.
        • Quirynen M.
        • van Steenberghe D.
        • Darius P.
        A six-year prosthodontic study of 509 consecutively inserted implants for the treatment of partial edentulism.
        J Prosthet Dent. 1992; 67: 236-245
        • Lee K.-Y.
        • Shin K.S.
        • Jung J.-H.
        • Cho H.-W.
        • Kwon K.-H.
        • Kim Y.-L.
        Clinical study on screw loosening in dental implant prostheses: a 6-year retrospective study.
        J Korean Assoc Oral Maxillofac Surg. 2020; 46: 133-142
        • McGlumphy E.A.
        Keeping implant screws tight: the solution.
        J Dent Symp. 1993; 1: 20-23
        • Huang Y.
        • Wang J.
        Mechanism of and factors associated with the loosening of the implant abutment screw: a review.
        J Esthet Restor Dent. 2019; 31: 338-345
        • Dellinges M.A.
        • Tebrock O.C.
        A measurement of torque values obtained with hand-held drivers in a simulated clinical setting.
        J Prosthodont. 1993; 2: 212-214
        • Hill E.E.
        • Phillips S.M.
        • Breeding L.C.
        Implant abutment screw torque generated by general dentists using a hand driver in a limited access space simulating the mouth.
        J Oral Implantol. 2007; 33: 277-279
        • Mahshid M.
        • Saboury A.
        • Fayaz A.
        • Sadr S.J.
        • Lampert F.
        • Mir M.
        The effect of steam sterilization on the accuracy of spring-style mechanical torque devices for dental implants.
        Clin Cosmet Investig Dent. 2012; 4: 29-35
        • Britton-Vidal E.
        • Baker P.
        • Mettenburg D.
        • et al.
        Accuracy and precision of as-received implant torque wrenches.
        J Prosthet Dent. 2014; 112: 811-816
        • Standlee J.P.
        • Caputo A.A.
        • Chwu M.J.
        • Sun T.T.
        Accuracy of mechanical torque-limiting devices for implants.
        Int J Oral Maxillofac Implants. 2002; 17: 220-224
        • Dellinges M.
        • Curtis D.
        Effects of infection control procedures on the accuracy of a new mechanical torque wrench system for implant restorations.
        J Prosthet Dent. 1996; 75: 93-98
        • Gutierrez J.
        • Nicholls J.I.
        • Libman W.J.
        • Butson T.J.
        Accuracy of the implant torque wrench following time in clinical service.
        Int J Prosthodont. 1997; 10: 562-567
        • Mahshid M.
        • Saboury A.
        • Sadr S.J.
        • Fayyaz A.
        • Kadkhodazadeh M.
        The combined effect of dismantling for steam sterilization and aging on the accuracy of spring-style mechanical torque devices.
        J Periodontal Implant Sci. 2013; 43: 221-226
        • Kazemi M.
        • Rohanian A.
        • Monzavi A.
        • Nazari M.S.
        Evaluation of the accuracy and related factors of the mechanical torque-limiting device for dental implants.
        J Dent (Tehran). 2013; 10: 112-118
        • Fayaz A.
        • Mahshid M.
        • Saboury A.
        • Sadr S.J.
        • Ansari G.
        The effect of sterilization and number of use on the accuracy of friction-style mechanical torque limiting devices for dental implants.
        Dent Res J. 2014; 11: 74-80
        • Sadr S.J.
        • Fayyaz A.
        • Mahshid M.
        • Saboury A.
        • Ansari G.
        Steam sterilization effect on the accuracy of friction-style mechanical torque limiting devices.
        Indian J Dent Res. 2014; 25: 352-356
        • Wood J.S.
        • Marlow N.M.
        • Cayouette M.J.
        Accuracy of dental torque wrenches.
        Gen Dent. 2015; 63: e20-e22
        • Stroosnijder E.
        • Gresnigt M.
        • Meisberger E.
        • Cune M.
        Loss of accuracy of torque wrenches due to clinical use and cleaning procedure: short communication.
        Int J Prosthodont. 2016; 29: 253-255
        • Yilmaz B.
        • L'Homme-Langlois E.
        • Beck F.M.
        • McGlumphy E.
        Effect of long-term steam autoclaving on changes in torque delivery of spring- and friction-type torque wrenches.
        J Prosthet Dent. 2016; 115: 718-721
        • Sadr J.
        • Fayyaz A.
        • Mahshid M.
        • Saboury A.
        The effect of aging on the accuracy of spring-style mechanical torque limiting devices for dental implants.
        Shahid Beheshti Univ Dent J. 2013; 31: 78-86
        • Saboury A.
        • Sadr S.J.
        • Fayaz A.
        • Mahshid M.
        The effect of aging on the accuracy of new friction-style mechanical torque limiting devices for dental implants.
        J Dent (Tehran). 2013; 10: 41-50
        • Liberati A.
        • Altman D.G.
        • Tetzlaff J.
        • et al.
        The PRISMA statement for reporting systematic reviews and meta-analyses of studies that evaluate health care interventions: explanation and elaboration.
        J Clin Epidemiol. 2009; 62: e1-e34
        • Page M.J.
        • McKenzie J.E.
        • Bossuyt P.M.
        • et al.
        The PRISMA 2020 statement: an updated guideline for reporting systematic reviews.
        BMJ. 2021; 372: n71
        • Sarkis-Onofre R.
        • Skupien J.A.
        • Cenci M.S.
        • Moraes R.R.
        • Pereira-Cenci T.
        The role of resin cement on bond strength of glass-fiber posts luted into root canals: a systematic review and meta-analysis of in vitro studies.
        Oper Dent. 2014; 39: E31-44
        • Soares F.Z.M.
        • Follak A.
        • da Rosa L.S.
        • Montagner A.F.
        • Lenzi T.L.
        • Rocha R.O.
        Bovine tooth is a substitute for human tooth on bond strength studies: a systematic review and meta-analysis of in vitro studies.
        Dent Mater. 2016; 32: 1385-1393
      1. Higgins J.P.T. Thomas J. Chandler J. Cochrane handbook for systematic reviews of interventions version 6.2 (updated February 2021) 10102 identifying and measuring heterogeneity. John Wiley & Sons, Chichester, UK2021
        • Hsu Y.-T.
        • Nair M.
        • Angelov N.
        • Lalla E.
        • Lee C.-T.
        Impact of diabetes on clinical periodontal outcomes following non-surgical periodontal therapy.
        J Clin Periodontol. 2019; 46: 206-217
        • Kılınç H.İ.
        • Albayrak H.
        • Tursun F.
        • Gümüş H.Ö.
        Accuracy of different types of wrenches fabricated by different implant manufacturers.
        Clin Dent Res. 2015; 39: 95-100
        • L’Homme-Langlois E.
        • Yilmaz B.
        • Chien H.-H.
        • McGlumphy E.
        Accuracy of mechanical torque-limiting devices for dental implants.
        J Prosthet Dent. 2015; 114: 524-528
        • Erdem M.A.
        • Karatasli B.
        • Dinçer Kose O.
        • et al.
        The accuracy of new and aged mechanical torque devices employed in five dental implant systems.
        Biomed Res Int. 2017; 2017: 8652720
        • Albayrak H.
        • Gumus H.O.
        • Tursun F.
        • Kocaagaoglu H.H.
        • Kilinc H.I.
        Accuracy of torque-limiting devices: a comparative evaluation.
        J Prosthet Dent. 2017; 117: 81-86
        • Vallee M.C.
        • Conrad H.J.
        • Basu S.
        • Seong W.-J.
        Accuracy of friction-style and spring-style mechanical torque limiting devices for dental implants.
        J Prosthet Dent. 2008; 100: 86-92
        • Çehreli M.C.
        • Akça K.
        • Tönük E.
        Accuracy of a manual torque application device for morse-taper implants: a technical note.
        Int J Oral Maxillofac Implants. 2004; 19: 743-748
        • Goldstein G.
        • Ghoujal B.
        • Abdullah S.
        An in vitro assessment of the accuracy of new and in-use torque-limiting devices.
        J Prosthet Dent. 2020; 124: 716-719
        • Schwarz M.S.
        Mechanical complications of dental implants.
        Clin Oral Implants Res. 2000; 11: 156-158
        • Tzenakis G.K.
        • Nagy W.W.
        • Fournelle R.A.
        • Dhuru V.B.
        The effect of repeated torque and salivary contamination on the preload of slotted gold implant prosthetic screws.
        J Prosthet Dent. 2002; 88: 183-191
        • Jaarda M.J.
        • Razzoog M.E.
        • Gratton D.G.
        Providing optimum torque to implant prostheses: a pilot study.
        Implant Dent. 1993; 2: 50-52
        • Goheen K.L.
        • Vermilyea S.G.
        • Vossoughi J.
        • Agar J.R.
        Torque generated by handheld screwdrivers and mechanical torquing devices for osseointegrated implants.
        Int J Oral Maxillofac Implants. 1994; 9: 149-155
        • Tan K.B.
        • Nicholls J.I.
        Implant-abutment screw joint preload of 7 hex-top abutment systems.
        Int J Oral Maxillofac Implants. 2001; 16: 367-377
        • Neugebauer J.
        • Petermöller S.
        • Scheer M.
        • Happe A.
        • Faber F.-J.
        • Zoeller J.
        Comparison of design and torque measurements of various manual wrenches.
        Int J Oral Maxillofac Implants. 2015; 30: 526-533
        • Tan B.F.
        • Tan K.B.
        • Nicholls J.I.
        Critical bending moment of implant-abutment screw joint interfaces: effect of torque levels and implant diameter.
        Int J Oral Maxillofac Implants. 2004; 19: 648-658
        • Honório Tonin B.S.
        • He Y.
        • Ye N.
        • Chew H.P.
        • Fok A.
        Effects of tightening torque on screw stress and formation of implant-abutment microgaps: a finite element analysis.
        J Prosthet Dent. 2022; 127: 882-889
        • McCracken M.S.
        • Mitchell L.
        • Hegde R.
        • Mavalli M.D.
        Variability of mechanical torque-limiting devices in clinical service at a US dental school.
        J Prosthodont. 2010; 19: 20-24
        • Karaman T.
        • Kahraman O.E.
        • Eser B.
        • Altintas E.
        • Talo Yildirim T.
        • Oztekin F.
        Evaluation of the accuracy of the mechanical torque wrench by the number of uses and ratchet type.
        Am J Dent. 2019; 32: 251-254
        • Tan K.B.
        • Nicholls J.I.
        The effect of 3 torque delivery systems on gold screw preload at the gold cylinder-abutment screw joint.
        Int J Oral Maxillofac Implants. 2002; 17: 175-183