Question

Any general tips that you’ve learned over the years to obtain good primary stability? I’ve learned bi-cortical stabilization at certain courses but just seeing if you had any other nuggets of wisdom.

Honestly, the best for this is just knowing how wide to prep your site. The softer the bone the less you prep. I basically always over-prep in terms of depth but I underprep in terms of width.

Here’s a chart I usually follow:

I want to reassure you that several studies show no correlation between high insertion torque (>25Ncm) versus low insertion torque (<30-35NCm) and long-term implant survival. I have personally had a number of spinners that I’ve buried and had a bad feeling about, only to uncover and find a totally solid implant.

Here are a couple of solid references:

• The Effects of High Insertion Torque Versus Low Insertion Torque on Marginal Bone Resorption and Implant Failure Rates: A Systematic Review With Meta-Analyses. Bernadini M. 2016.
• The Influence of Low Insertion Torque on Primary Stability, Implant Survival, and Maintenance of Marginal Bone Levels: A Closed-Cohort Prospective Study. Norton M. 2017.

However you do need primary stability. AKA no implant movement.

The easiest way to achieve this is underprep width, overprep length.