Impact of Abutment Screw Torque on Marginal Bone Loss

This study aims to analyze how different torque levels applied during transmucosal abutment placement on dental implants influence peri-implant tissue health and other relevant clinical parameters. A randomized clinical trial will be conducted in which each participant will receive three dental implants. Each implant will be assigned to one of the following conditions: an abutment torqued to 15 Ncm, an abutment torqued to 30 Ncm, and a submerged implant with a healing cap, without immediate transmucosal connection.

This intra-individual design enables direct comparison of outcomes while minimizing inter-individual variability that could affect the results.

Throughout the treatment process, various data will be collected. During surgery, patient-reported comfort levels will be recorded. Following prosthesis placement, standard clinical measurements will be performed, including peri-implant probing, bleeding on probing, inflammation, and radiographic evaluation of marginal bone loss.

Additionally, patient-reported outcomes during the first week after the initiation of the prosthetic phase will be documented, including pain levels, inflammation, and analgesic use. Overall satisfaction and the impact of treatment on quality of life will also be assessed using a Likert-type scale, focusing on functions such as chewing, speech, sleep, and daily activities.

The goal of this study is to determine whether the torque applied during abutment connection has a clinically relevant effect on both peri-implant tissue response and patient perception of the treatment. The findings may contribute to improved clinical guidelines in implant dentistry and enhance long-term treatment outcomes.

The study protocol has been approved by the relevant ethics committee and will comply with all applicable clinical research regulations. All participants will provide written informed consent prior to enrollment.

Inclusion criteria

• Posterior edentulism
• Completion of craniofacial growth
• Full-mouth plaque index and bleeding index < 25%
• Sufficient bone height and width for implant placement without the need for bone regeneration procedures
• Presence of at least 2 mm of keratinized mucosa around the dental implant
• Stable occlusion and healthy periodontium
• Absence of medical conditions that contraindicate implant surgery, such as heavy smoking (<10 cigarettes per day), severe bruxism, pregnancy or breastfeeding, bisphosphonate therapy, and patients undergoing chemotherapy or radiotherapy in the head and/or neck area
• Uncooperative patients

Exclusion criteria

• Loss to follow-up
• Incorrectly parallelized periapical radiographs