Insertion Torque Value and Implant Stability Quotient of Bone-Level Versus Tissue-Level Dental Implants: A Pilot Randomized Clinical Trial

This randomized clinical trial aimed to assess the relation of insertion torque value (ITV) and implant stability quotient (ISQ) between bone-level (BL) and tissue-level (TL) dental implants (ISQ recorded immediately and 3 months after implant placement). A total of 90 dental implants (44 BL, 46 TL; BioHorizons Camlog, Iberica) were placed in 21 patients. ITV was recorded at placement. ISQ (Penguin device, Klockner) was measured horizontally (ISQ-H) and vertically (ISQ-V) at baseline and at the 90-day follow-up. The Mann–Whitney U test and Spearman's correlation tests (α = 0.05) were used for the analyses. No significant difference in ITV was found between the BL (36.0 ± 11.5 Ncm) and TL (38.0 ± 11.5 Ncm) groups (p = 0.381). Similarly, no significant differences were observed in baseline ISQ-H (p = 0.928) or ISQ-V (p = 0.874). At 90 days, ISQ-H values were marginally higher in the TL group (66.5 ± 20.9) compared to the BL group (57.1 ± 18.9; p = 0.029). A significant positive correlation was found between ITV and baseline ISQ (r = 0.493, p < 0.001), but not with 90-day ISQ values. Implant design (BL vs. TL) did not significantly influence ITV or ISQ. The finding of greater horizontal stability for TL implants at 90 days, while marginal, suggests a potential long-term biomechanical difference warranting further study. The dissociation between insertion torque and 90-day stability indicates that secondary stability is governed by factors beyond initial mechanical engagement.