What Factor Affects the Torque Applied to the Wrench?

• Research
• Open Access
• Published: 15 July 2021

Experimental study on the factors affecting torque of beam-type implant torque wrenches

• Yuji Sato¹,
• Junichi Furuya¹,
• Tokiko Osawa^ane,
• Akio Isobe¹,
• Myu Hayashi¹ &
• Noboru Kitagawa¹

BMC Oral Wellness volume 21, Article number:344 (2021) Cite this article

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Abstract

Background

Screw breakage and loosening are the most mutual mechanical complications associated with implant treatment, and they may occur due to excess or inadequate spiral tightening torque. When fastening and fixing the implant superstructure, screws are tightened using a torque wrench, which is essential for an authentic tightening forcefulness. Even so, the characteristics of the torque wrench have not been fully verified. Therefore, we aimed to analyze the factors affecting the torque with a focus on beam-blazon torque wrenches, which are the primary types of wrenches.

Methods

The torque values generated by beam-type torque wrenches from eight manufacturers were measured using a torque gauge. To investigate the influence of the location of the beam relative to the calibration, measurements were performed with a calibration aligned with the trailing edge, middle, and leading edge of the beam respectively. Additionally, measurements were taken at xc°, lx°, and 30° to examine the consequence of the angle at which the examiner read the torque value. Nether each condition, a single examiner applied the recommended torque to each manufacturer's screws five times in a clockwise direction. The average measured torque, standard divergence, bias, and coefficient of variation were calculated and compared accordingly.

Results

Wrenches from vi manufacturers demonstrated excellent accuracy for measurements at the center of the axle (bias within ± iv%). For measurements at 90°, equipments from v manufacturers displayed excellent accuracy (bias within ± 7%), and seven showed excellent repeatability (coefficient of variation ≤ two%).

Conclusion

The calibration should exist aligned with the heart of the beam and read from xc° while using a torque wrench. The accurateness and repeatability torques generated by the wrenches differed co-ordinate to the manufacturer, scale width, calibration line width, axle width, and distance between the scale and axle center. Based on these results, we suggest that a torque wrench must be selected later determining the difference in the structure of the torque wrench.

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Background

Oral implants are widely used in prosthodontic handling [i,2,3,4]. Although implant treatment has a high success charge per unit of > 90%, mechanical complications can occur [5], with 1 of the nearly common complications being screw breakage and loosening [6, 7]. This can lead to issues such as impairment to the surrounding os tissue and loss of osseointegration [8,9,10,xi,12]. Factors that can crusade these types of mechanical complications include incompatibility between the abutment and superstructure, repeated bending movements, initial loosening of the tightened screw, insufficient spiral strength, and insufficient or excessive tightening forcefulness applied to the spiral [13]. In particular, forces practical to screws are either frequently inadequate or excessively tightening and are afflicted by a variety of factors. This written report focused on insufficient or excessive screw tightening force, which is a typical mechanical complication.

During the concluding fixation of the implant superstructure, the screws were tightened using a torque wrench. The utilize of a torque wrench is essential for an authentic tightening forcefulness [xiv].

Owing to the dissimilar implant and abutment connection designs, the recommended insertion torques are unlike [fifteen,16,17]. Fixing screws are particularly difficult, and large fluctuations in the applied torque have been measured in vitro. To this end, torque wrenches of various designs have been introduced appropriately[xviii]. Applying controlled torque allows for long-term functional loading of components. Torque wrenches should accurately display the torque applied to avert complications during surgical and prosthetic procedures [19,twenty,21].

Torque wrenches are broadly classified into two types: mechanical and digital, with the old being further classified into axle and preset types. Diverse designs for manual torque wrenches are available. A digital torque wrench displays the torque digitally, a preset-blazon wrench stops applying force when a preset torque is reached, and a beam-type wrench passively displays the torque reached accordingly.

By comparing different designs from the same manufacturer, loftier torque values were obtained for the preset and beam-type devices [22]. Axle-type devices showed a more than consistent range of values [22, 23]. A manual torque wrench has a mechanical design that requires proper maintenance [24, 25]. A study involving new unused devices and older devices used under normal clinical conditions showed significant fluctuations above and beneath the set torque value. [16, 25]

In add-on, the torque exerted by an industrial torque wrench is affected by the blazon and construction of the torque wrench and the position of the examiner [26].

Co-ordinate to recent data, the variations depend on the device design and the torque level selected.

However, properties such as the accuracy and repeatability of mechanical handheld torque wrenches for oral implants have not been fully verified.

This study aimed to contribute to the long-term prognosis of implant treatment by clarifying the factors affecting torque exertion. The naught hypothesis was that the torque wrench was unaffected by the operator's reading angle and axle location.

Methods

Materials

Because the global market share, the post-obit eight axle-blazon wrenches were selected: Ratchet (Institut Straumann Ag, Basel, Switzerland), Manual Torque Wrench Prosthetic (Nobel Biocare, Zürich-Frughafen, Switzerland), ex torque wrench (Kyocera Medical Corporation, Osaka, Japan); GC Implant Re and Surgical Instrument Torque Wrench (Gc, Tokyo, Japan), Torque Ratchet Wrench (Ktc, Kyoto, Nippon); mono torque ratchet (Thommen, Grenchen, Switzerland), torque wrench (Nippon Piston Ring Co., Saitama, Japan), and Biofix Torque wrench (Shofu, Kyoto, Japan) (Fig. 1). All torque wrenches were new and previously unused.

Fig. ane

Torque wrenches studied. a Ratchet, Found Straumann Ag, Basel, Switzerland. b Manual Torque Wrench Prosthetic, Nobel Biocare, Zürich-Frughafen Switzerland. c Ex Torque Wrench, Kyocera Medical Corporation, Osaka, Japan. d GC Implant Re and Surgical Instrument Torque Wrench, Gc, Tokyo, Japan, e Torque Ratchet Wrench, Ktc, Kyoto, Japan. f Mono torque ratchet, Thommen, Grenchen, Switzerland. g Torque wrench, Nippon Piston Ring Co, Saitama, Nihon. h Biofix Torque wrench, Shofu, Kyoto, Japan

Total size image

Choosing a torque wrench

Although many types of torque wrenches be, beam-type torque wrenches exhibit the smallest deviations from the set values [22, 23]. We considered it clinically relevant to analyze the characteristics of beam-type wrenches used in clinical exercise. Thus, in this written report, we selected eight torque wrenches that are often used clinically in implant treatment, taking into consideration their market share.

Measurement device

A screwdriver (Screwdriver Machine Unigrip 20 mm, Nobel Biocare, Japan) and a torque gauge (BTG36CN, Tohnichi, Japan) were fixed (Fig. 2), and the torque exerted by each torque wrench (actual measured torque values) was measured using a Latin foursquare design.

Fig. 2

Torque wrench and torque judge fixed

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Measurement of the torque value

The aforementioned examiner, who was experienced in implant treatment, applied the recommended torque to each manufacturer'due south prosthetic screws (target torque value) 5 times in a clockwise direction (Table i). The average of the 5 measured torque values (average measured torque value) was calculated and recorded accordingly. The bias, which was the difference between the average measured and target torque values divided past the target torque value, was used as an index of accurateness. The coefficient of variation, which was the standard divergence of the measured torque value divided by the average measured torque value, was used as an index of repeatability.

Table 1 Target torque value (recommended torque value for prosthetic screws of each visitor)

Full size tabular array

Measurement of the part of the beam to be aligned

To investigate the influence of the location of the beam relative to the scale, measurements were performed with a scale aligned with the trailing border, centre, and leading edge of the axle (Fig. 3). We analyzed whether the construction of the torque wrench influenced the part of the beam to be aligned to the scale. Thus, the torque value per millimeter of the scale, width of the scale line, and width of the beam were measured and compared with the bias and the coefficient of variation. For statistical analysis, a paired t-exam was performed with Bonferroni correction. Depending on the part of the beam studied, the calculated bias for the leading edge, center, or trailing edge of the beam was used as the dependent variable for accuracy. Similarly, the coefficient of variation of the leading edge, center, or abaft edge of the axle was used equally the dependent variable for repeatability according to the position of the calibration on the beam. The significance level was ready at 5%. Additionally, the divergence in torque values between the leading and abaft edges, and the coefficient of variation in the center, were set equally dependent variables. Pearson's correlation coefficient was calculated betwixt each dependent variable and the following three items: torque value per millimeter of scale, beam width, and scale line width. The significance level was set at 5% (Tables 2, 3). IBM SPSS Statistics 25.0 (IBM, Chicago, USA) was used for the statistical analyses.

Fig. three

Location of the beam on the scale. a leading edge, b center, c trailing edge

Full size prototype

Table two Correlation coefficients for items related to accuracy depending on the part of the axle aligned with the scale

Full size table

Table 3 Correlation coefficients for items related to repeatability depending on the part of the beam aligned with the scale

Total size table

Effect of the angle at which the examiner read the torque value

Measurements were recorded at 90°, sixty°, and 30° to examine the issue of the bending at which the examiner read the torque value (Fig. 4). Nosotros analyzed whether the structure of the torque wrench influenced the bending at which the examiner read the torque value. Thus, the width of the scale line, the width of the axle, and the distance between the scale and center of the beam were measured and compared with the bias and the coefficient of variation. For statistical analysis, a paired t-test was performed with Bonferroni correction. In terms of both accuracy and repeatability, depending on the angle at which the examiner read the torque value, deviations of 90°, 60°, and thirty° were used as dependent variables. The significance level was ready at 5%. Additionally, the difference in torque values between 90° and 60° and the coefficient of variation when viewed from sixty° were set up equally dependent variables. Pearson's correlation coefficient was calculated between each dependent variable and the following three items: axle width, calibration line width, and distance between calibration and axle eye. The significance level was set at 5% (Tables four, 5). IBM SPSS Statistics 25.0 (IBM, Chicago, Usa) was used for the statistical analyses.

Fig. iv

Angle at which the examiner reads the torque value

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Table 4 Correlation coefficient for items related to accuracy depending on the angle at which the examiner read the torque value

Full size table

Table 5 Correlation coefficients for items related to repeatability depending on the angle at which the examiner read the torque value

Full size table

Results

Comparison of the accuracy and repeatability depending on the office of the axle aligned with the scale

The bias and the coefficient of variation, which are indicators of the accuracy of various torque wrenches, were used for comparison (Fig. 5, Table vi). There was a meaning difference in bias between the groups; however, the coefficient of variation was not significantly different between the groups (P > 0.05). For the wrenches from five manufacturers, the highest accurateness and repeatability (bias within ± iv%) was observed when the center of the beam was aligned with the center of the scale. Every bit the alignment of the scale shifted from the leading edge to the abaft edge of the axle, the exerted torque tended to increment (difference in the maximum average measured torque value: ± nine Due north cm). There was a significant departure in bias between the leading and trailing edges of the same manufacturer, from 12% for the smallest difference to 88% for the largest difference. Wrenches with a greater departure in bias between the leading and trailing edges demonstrated higher values of torque per millimeter scale, width of the axle, and width of the scale line. The correlation coefficient for the difference in torque values betwixt the leading and trailing edges and the torque value per millimeter of the scale, beam width, and scale line width were 0.94, 0.57, and 0.72, respectively (Tabular array ii). Additionally, we observed a trend for the values of torque per millimeter of the scale, beam width, and scale line width to increase for wrenches with a higher coefficient of variation in the center. The correlation coefficients between the cardinal coefficient of variation and the torque value per millimeter of the scale, axle width, and scale line width were 0.47, 0.29, and 0.83, respectively (Table 3).

Fig. five

Comparison of the accurateness and repeatability depending on the function of the axle aligned with the scale

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Table vi Comparing of the accurateness and repeatability depending on the function of the beam aligned with the scale

Total size table

Comparing of the accuracy and repeatability according to the angle from which the examiner read the torque value

The bias and coefficient of variation, which are indices of the accuracy of diverse torque wrenches, were used to compare the demonstrated torque values of wrenches from 7 manufacturers (Table seven). The bias was significantly unlike but between the 90° and 60° groups, and the coefficient of variation was significantly different between the 90° and 30° groups and the 60° and 30° groups respectively (P < 0.05). When the angle of torque reading was ninety°, wrenches from five manufacturers demonstrated excellent accuracy (within ± 7% bias), and those from seven manufacturers showed excellent repeatability (inside 2% coefficient of variation) (Fig. 6). The divergence in the bias between ninety° and 60° varied greatly among the manufacturers, ranging from 2% for the smallest departure to 33% for the largest difference. The correlation coefficients for the departure in torque values betwixt the 90° and 60° angles of view and the torque value per millimeter, distance betwixt the calibration and the center of the beam, and width of the scale line were 0.45, 0.90, and 0.41, respectively (Table 4). The correlation coefficient for the coefficient of variation when viewed from 60° and the torque value per millimeter of the scale, distance betwixt the scale and the center of the axle, and width of the scale line were 0.76, 0.57, and 0.82, respectively (Table 5).

Tabular array 7 Comparing of the accurateness and repeatability according to the angle at which the examiner read the torque value

Total size tabular array

Fig. 6

Comparison of the accurateness and repeatability co-ordinate to the angle at which the examiner read the torque value

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Give-and-take

The effect of the function of the beam aligned to the scale

Correct torque awarding on implant components has been a problem since the early on days of modern implant dentistry [14, sixteen, 27,28,29]. Moreover, studies have shown that in an industrial torque wrench, the magnitude of the volitional torque is strongly influenced by the type of tool used and the posture causeless accordingly [26]. Similarly, in oral implant torque wrenches, the torque is likely to be influenced by the structure of the wrench and the operator'due south posture. The structure is thought to exist influenced past the beam and the position of the scale pointer. In this study, the torque applied was significantly more authentic when the scale was aligned to the center of the beam. Although no significant difference was observed, reproducibility was highest when the scale was aligned with the heart of the beam for the wrenches of many manufacturers. It was hence suggested that the scale should be fix at the center of the axle when handling torque wrenches. Additionally, the torque wrenches were greatly affected past the function of the beam that was adapted to the scale. Thus, it was ended that the part of the axle adjusted to the scale and the structure of the torque wrench may exist related to each other. The structures of the torque wrenches were farther analyzed to clarify the human relationship between the structure of the torque wrenches and part of the beam to exist aligned with the scales. The beam was a cantilever, so angle was not linear and was governed by an equation [30]; thus, the linear scale used for markings was not accurate but could be approximated. In ane of the torque wrenches used in this study, the distance between the 35 North cm marker and the 15 N cm marking was 5.five mm, resulting in a torque value of iii.6 N cm per millimeter. The theoretical value of the error at the trailing and leading edges of the beam could be calculated since the width of the beam was ane mm. It was suggested that the width of the beam, which is the construction of the torque wrench, was influenced past the role of the axle that is adjusted to the scale (Fig. 7). The correlation coefficients suggested that the torque value per millimeter of the scale and the width of the scale line significantly affected the accuracy, and that the width of the line in turn significantly affected the repeatability. Based on the results of the present written report, it tin can exist concluded that it is desirable to adjust the scale to the middle of the beam and consider both the influence of the torque value per millimeter of the calibration and the width of the beam for each wrench.

Fig. vii

Consideration of the effect of the part of the beam aligned with the scale

Full size image

The angle at which the examiner read the torque value

The torque value was significantly more accurate when the examiner read information technology from a ninety° angle than from a 60° angle, and was significantly more reproducible when read from 90° than from 30°. The accurateness and repeatability were both highest at a reading angle of 90° for the wrenches of most manufacturers. Thus, it was suggested that the torque wrench should exist read and used at 90°. Additionally, torque values were greatly affected by the angle at which the examiner read them. Thus, it was suggested that the effect of the bending at which the examiner reads the torque value might be related to the structure of the torque wrench. The structures of the torque wrenches were further analyzed to clarify their relationship with the angle at which the examiner read the torque value. In one of the torque wrenches used in this study, the distance between the scale and the center of the axle was 2 mm, and the distance between the betoken where the scale was read from sixty° and the actual point perpendicular to the center of the axle was 1.15 mm. The torque value per mm was 3.half-dozen Due north cm, equally mentioned previously. The theoretical value of the error was calculated by multiplying the torque value per mm and the distance between the bespeak at which the scale was read from 60° and the vertical signal at the center of the beam; thus, it was suggested that the distance betwixt the center of the scale and the center of the beam was a factor affecting the angle (Fig. 8). The correlation coefficients suggested that the distance between the scale and the center of the beam significantly affected the accuracy, and that the torque value per millimeter of the calibration and the width of the scale line significantly affected the repeatability. Therefore, the nowadays study indicates that information technology is desirable to adjust the scale to the center of the beam and consider the influence of the torque wrench after considering the effects of the distance between the calibration and the centre of the beam, the width of the scale line, and the torque value per millimeter of the torque wrench scale for each manufacturer.

Fig. viii

Consideration of the upshot of the bending at which the examiner reads the torque value

Full size epitome

Strengths and weaknesses in relation to other studies

Neugebauer et al. determined and compared the accuracy of manual wrenches, which were available in dissimilar designs with a big range of preset torques. Three different designs were available, with a jump-in-coil or toggle pattern as an active mechanism or a beam equally a passive mechanism to select the preset torque. Beam wrenches are associated with a lower run a risk of extreme values because of their passive mechanism of achieving the selected preset torque, which minimizes the risk of harming screw connections [31]. In a previous written report, nosotros found that axle-blazon torque wrenches were more than accurate than other types of torque wrenches. Nosotros studied this aspect further in this written report and found that the accuracy and repeatability of the beam-type torque wrench depended greatly on its structure. Regarding the details of the structure, we found that the torque value per millimeter of the calibration, the width of the scale line, and the distance between the scale and the center of the beam afflicted the accuracy, while the torque value per millimeter of the scale and the width of the scale line greatly afflicted the repeatability.

Limitations of this study and future perspectives

A limitation of this study is that the torque was measured by a single examiner; therefore, inter-examination measurement error was not considered accordingly. Additionally, since a single torque wrench from each manufacturer was used for the measurements, individual differences were not predictable in the study. This factor should be considered in future studies.

In the clinical environment, the accuracy and repeatability of torque wrenches modify attributable to metal fatigue, crumbling deterioration due to sterilization and cleaning, and wet weather condition in the oral cavity. Thus, the effect of aging on the accuracy and repeatability of torque wrenches and the prognostic effect of errors in tightening torque values must be clarified in futurity studies.

Decision

We propose that the torque wrench should be read from 90° to the center of the axle aligned to the calibration. As observed, accuracy and repeatability differed amid the wrenches from unlike manufacturers. This was related to the torque value per millimeter of the scale, width of the calibration line, width of the beam, and distance between the scale and the center of the beam. Thus, a torque wrench must be selected based on the manufacturer'south understanding of the structural differences.

Availability of information and material

The datasets used and/or analyzed during the current study are available from the corresponding author upon reasonable request.

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Acknowledgements

The authors would similar to express their deep appreciation to the education staff of the Geriatric Dentistry course at Showa University Dental Infirmary for their help and cooperation. We would like to thank Editage (www.editage.com) for English language editing.

Funding

This report was supported by a Grant-in-Aid for Scientific Research from the Ministry of Education, Civilisation, Sports, Science, and Engineering (Showa University Grant-in-Aid for Scientific Research (C)) (Grant Number 16K11657).

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1. Department of Geriatric Dentistry, Showa University School of Dentistry, Ota Ward, Tokyo, Japan

   Hiroki Shiba, Yuji Sato, Junichi Furuya, Tokiko Osawa, Akio Isobe, Myu Hayashi & Noboru Kitagawa

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HS drafted the manuscript. YS advised the manuscript. All authors read and approved the last manuscript.

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Correspondence to Hiroki Shiba.

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Shiba, H., Sato, Y., Furuya, J. et al. Experimental report on the factors affecting torque of axle-type implant torque wrenches. BMC Oral Health 21, 344 (2021). https://doi.org/10.1186/s12903-021-01703-z

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• Received: 13 Jan 2021

• Accepted: 07 July 2021

• Published: xv July 2021

• DOI : https://doi.org/x.1186/s12903-021-01703-z

Keywords

• Implant
• Mechanical complication
• Torque wrench
• Prosthetic screw

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