Torque Testing Straumann Implants: How?

Straumann has a similar tool like the ratchet/torque wrench of the Nobel system. Lift the tray with the drill bits and you will find them in the bottom compartment. It comes in two parts - a ratchet and a torque sleeve - and you have to insert the ratchet into the torque sleeve to form a torque wrench. All you need to do is 1)to loosen the finger screw on the ratchet and disassemble it. 2) reassemble the ratchet inside the sleeve. In practice, you will find that very few people actually use a RFA machine to measure the ISQ of each of the implant inserted.

Hi Dr Chan, Thanks for the speedy response! Just to clarify, I know how to use the Straumann ratchet and torque wrench, but I'm asking what piece to put in it to torque test the implant. The Nobel implant driver fits inside the implant with the internal trilobe connection, but I don't know how to do the same with Straumann. After placing the implant, the transfer part is removed (unscrewed) - so what part can I use in the ratchet to engage the internal connection of the implant? I use the SCS screwdriver to remove the healing abutment, but what piece fits inside the fixture for me to apply counterclockwise torque? Thanks!

You have to sterilize and reuse the transfer. Only the transfer fit the adapter. Have fun!

dr chan, you are wrong. the dr is asking how to apply reverse torque to a straumann implant. any implant that is delivered with a mount requires a removal tool to apply reverse torque. if you do as you say, and just put the mount back in, and then apply reverse torque, you will just be unscrewing the mount. straumann has implant removal tools to apply reverse torque. I do not recomend that you use them for this purpose, as they are actually for explantation and will be very clumsy for that purpose. the straumann implant system has many hidden features, this being one of them. I found out about it years ago when I tried to back a freshly placed fixture out to position it more crestally. I quickly realized that the mount only works in a forward direction. You need to ask your rep for all of these gizmos, as they will not be presented to you. Odds are your rep won't even know about them. regarding a reverse torque test-- i recomend using clinical judgement, watching your patient when you unscrew the healing abutment, possibly an RFA if you know how to use it correctly. As an experienced implant practitioner, I love the Straumann system. But for a beginner, there are many subtle nuances that must be learned by the occaisional misadventure.

Thank you both for your input. I suppose I have been left a bit confused by the contrasting responses. I had considered using the transfer part in the manner described by Dr Chan, but as mentioned by SB, I would imagine that applying reverse torque would merely unscrew the part again, rather than engaging the implant and torque testing it. Again, I do not have RFA, and I would like to be able to physically torque test the implant stability, rather than simply relying on percussion and clinical judgement. I generally only hand-tighten the healing abutment, which surely wouldn't create torque much higher than 5-7 Ncm, so I wouldn't be confident in using this as my only gauge. If anyone has any further input or elaboration on how to test the implant to a reverse torque of 35Ncm, I'd be very appreciative! Thanks again to those who've responded already.

Only way to apply reverse torque with straumann implants is with the explantation tool. It's an adapter that screws into implant and then it will fit in your torque wrench. Different tools for bone level and tissue level lines as well as diameters. As I stated it's a bit clumsy for this purpose, but it's the only way i'm aware of to apply reverse torque to straumann implants. Anyone out there please correct me if I'm wrong.

Hi I suppose one way of looking at it is if you reverse torque and the implant disengages, then would the same not happen if you forward torqued the implant? An implant which is not integrated would spin or pt would have discomfort/pain deep seated, if torqued at high level…i usually go to 25N for straumann bone levels when tightening my abutments. So how can we test this without the abutment being fabricated..i suppose on way could be to torque the healing abutment (forward)and see if it spins…25N seems quite enough… Sorry if ive misunderstood the post

when i use the straumann system, i use without an implant mount i have instruments that fit the handpiece or a torque wrench and can be used in reverse for explantation or just to test the torque before abutment and crown placement or forward as for placement of the implant. god luck. i am sure your rep will be knowledgeable to provide you with the correct pieces and parts. it is a shame that one of the previous drs. had bad stuff to say about his rep. maybe he needs a new rep

I am not a user of the Straumann system, and therefore not familiar with the nuances of it. What the good doctor did not tell us in his question is how long the implant has been in place and whether it is a delayed load or immediate loading situation. If an implant is placed in D1 bone and is torqued in with 40-70 Ncm of force, and an Ostel machine is used at the same time to determine the RFA, it can be misleading, because it will give the same result of a fully integrated implant. Reverse torquing an implant that is not yet integrated can destroy the possibility of this implant's success. It has been my experience for more than 30 years, that the simplest way to test the degree of osseointegration for an implant placed three-four months previous, is to gently reverse the cover screw, and see if the patient has any sensation or pain...that being done, a healing collar can be placed and further force in a clockwise direction can be applied, all the while watching for signs of any discomfort or movement. Should slight sensitivity be noticed in the clockwise direction, then it is an indication that osseointegration has not yet been achieved.....but in this manner, whatever degree of integration has taken place, will not be damaged as it will with a counterclockwise force.........generally, leaving the implant in a dormant untouched state a while longer can help it achieve osseointegration providing there is no pathology present. Dr. Gerald Rudick Montreal, Canada

You can reverse torque and forward torque check with the removal tool. It is an unlisted item from the manufacturer (well known secret), especially if you are in the US. It is also called the 24 hr removal tool for implants. Different implant sizes require different removal tools, and the bone level will not work in the standard plus implants due to a different internal chamber. ISQ only measures lateral stability, which may or may not correlate to torque stability. I personally have an implant with ISQ of 70, but was a spinnner. I THINK the machine is useless, i would much rather torque test my implants than use the ostell. Again, that is my opinion not a fact. DR S, why would you go against manufacturer's (Straumann's) recommendations to torque all final abutments to 35 N/cm2? I believe they have done a lot of research and development to quantify a certain torque strength to prevent loosening of screws.

I just forward torque it with the restorative abutment or healing abutment. Can't really reverse torque it without using the 48 hour tool. If you torque it to 35 ncm without it breaking loose, you're good.

I'm not sure I'd reverse torque *any* dental implant, let alone a Straumann. If you apply forward torque and the patient becomes *very* uncomfortable or the implant begins to turn, then just leave as is for another month and it will usually be OK. One of the problems with Straumann implants is that if you put on a solid abutment and then torque it and find it's not ready, there's really no way to get the solid abutment off to replace it with a healing cap. One of the best ways to tell if a Straumann is ready is to tap the healing cap with the reverse end of a mouth mirror. If you get a good hollow sound (as opposed to a dull thunk), and two months or more have passed since insertion, the implant is good to go. The only other way, as mentioned above, is with the implant removal tool, But the mirror thunk test, which Bob Pendry taught me in 1996, has never failed.

Dear Dr. G you can always find Zimmer Swiss plus's driver which fit Straumann’s internal-octa's driver and use nobel's torque control for the test. It work for the trans-mucosal implant. But I don't know if there is a driver similar for bone level one.

The ways I have seen 1- tap on cap ( listen for solidness) 2-radiograph analysis 3- torque test -forward or reverse. Healing cap(forward only) removal tool (both directions) 4- RFA- costly and controversial to some degree 5- just general wait and see past 4-6 make sure no grafting was done or wait longer PS It is not really accurate to torque test at insertion but it can give you an idea of stability You can only torque test with an integrated Implant or metal to metal such as healing cap or abutment to implant PPS Note that a morse tapered connection such as the Straumann solid abutment has increased torque upon removal rather than insertion If you torque to 35 the removal is 42ish Disclaimer I work for Camlog implants

Thank you to everyone for the in-depth responses. Just to clarify some detail that I may have omitted in my original response: - I am not asking about applying reverse torque at the placement appointment. I'm placing the implants, generally as one stage with healing abutment (but occasionally as two-stage with cover screw as required), and then allowing 8-12 weeks for integration. - My understanding of the evidence tells me that 2-3 months is generally plenty of time for integration if primary stability is achieved and bone quality is good, and the SLActive surface has shown good results within this timeframe. I will not be loading the implants at all until integration is confirmed. - I do not have access to RFA machines, nor will I any time soon, so while I appreciate the suggestion from those who like to use them, this is not something I will be using. - I'd prefer not to forward torque the healing abutment to 35Ncm only to then remove it - I'd be much more comfortable if there was a way I could torque test the implant without the abutment on. Before removing it, I percuss the implant and take a PA radiograph, but I'd still like to torque test it. - when I used the Nobel system, I was able to just engage the implant driver in the internal connection of the fixture, and use the torque wrench and apply 35Ncm in reverse to confirm stability. As I am now in a clinic that only uses Straumann, I'm just looking for an equivalent piece of equipment which can be used to engage the internal connection on the Straumann implants. - I notice a few people have mentioned a 'removal tool' o '48 hour tool', which is unlisted in the Straumann catalogue. Is there a reason it's not listed? My rep is away on holiday this week, so I'll call her next week. The only tool I've seen for removing implants is the 'explantation tool' which, as I understand it, is just a drill to trephine the implant out (certainly a last resort, and obviously not what I'm looking for!). The 48 hour tool, as it has been described here, sounds like the tool I need, so I'll ask my rep. Thanks again for all of your posts. I really appreciate it the feedback, and as always on this forum, there's been informative discussion and many different points of view. Cheers, G

This comment was deleted, so I will re-iterate, ask your rep. If he or she doesn't know, then Straumann needs to hear about it. Their representatives are very informed, in my part of the world. Bv