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Journal of Oral Science & Rehabilitation Volume 2 | Issue 4/2016 71 E f f e c t s o f i n s e r t i o n t o r q u e o n h a r d a n d s o f t t i s s u e a f t e r t w o y e a r s The FSTLand ΔFSTLwere also examined around implants, dividing the results into Group A and Group B according to the thickness ofthe buccal bone afterthe osteotomypreparation, measured at the time of implant insertion (Table 4). The FSTL and ΔFSTL in the high-IT group showed differences between the values registered for GroupAand in Group B. In fact, at the 24-month follow-up, the implants in GroupAinserted with a high IThad greatersoft-tissue recession (FSTL: -1.03 ± 0.34 mm; ΔFSTL: -1.15 ± 0.36 mm) com- pared with Group B (FSTL: -0.50 ± 0.57 mm; ΔFSTL: -0.67 ± 0.66 mm). Moreover, the BBT in the regular-IT group had an influence on facial soft-tissue behavior. In fact, the soft-tissue re- cession in GroupA(-0.21 ± 0.42 mm)was great- er than in Group B (-0.09 ± 0.42 mm) after two years. Discussion The clinical and radiographic outcome of im- plants inserted with a high IT (50–100 N cm) and regular IT (< 50 N cm) in healed ridges were compared in this study. The outcome variables considered were FSTL, measured clinically, and MBL, analyzed through radiographs. Also, the influence ofBBTafterimplant osteotomyonthe facial soft-tissue changeswas investigated.The implant cumulative success rate was registered in each group and all experimental sites were followed for two years. Only one implant per patient was inserted, in order to exclude possi- ble cluster effects onthe implant outcome. Only nongrafted sites were included to eliminate the possible influence of a biomaterial previously grafted in the surgical sites, although implants inserted in grafted sites have been demonstrat- ed to have survival rates similar to that of im- plants inserted in nonaugmented sites.16, 17 Measures were taken at baseline and at three, six, 12 and 24 months, providing the pos- sibility of analyzing the outcomes after both the first and the second year of follow-up. This would help in studyingthe hard- and soft-tissue changes after implant loading. The achievement of good primary stability when inserting an implant has been found to be important, mostlywhen applying an immediate loading protocol.18 A higher IT makes the clini- cian feel more comfortable while inserting an implant, as it appears to mimic implant pri- mary stability.19, 20 In the present study, implants inserted with an ITthat exceeded 50 N cm had more pronoun- ced periimplant bone resorption and soft-tissue recession than implants with an IT within 50 N cm, and this result was more evident in the mandible.Thesefindings are in linewiththat of other studies.21 In fact, implants inserted in the anterior maxilla with a high IT (ranging from 50 N cm to 80 N cm), immediately or early loa- ded, and followed for one year showed signifi- cant differences between the bone resorption at each time point.21 Table 2 MBL (mean ± standard deviation) and ΔMBL at 24 months in the maxilla and mandible for the high- and regular-IT groups. Table 3 FSTL (mean ± standard deviation) and ΔFSTL at 24 months in the maxilla and mandible for the high- and regular-IT groups. Table 4 FSTL (mean ± standard deviation) and ΔFSTL (mean ± standard deviation) in sites with BBT < 1 mm (Group A) and BBT ≥ 1 mm (Group B) for the high- and regular-IT groups. FSTL at baseline FSTL at 24 months ΔFSTL at 24 months Group A High IT 0.11 ± 0.32 -1.03 ± 0.34 -1.14 ± 0.36 Regular IT -0.21 ± 0.42 0 -0.21 ± 0.42 P-value 0.3423 0.0001 0.0001 Group B High IT 0.17 ± 0.39 -0.5 ± 0.57 -0.67 ± 0.66 Regular IT 0.06 ± 0.33 -0.02 ± 0.26 -0.09 ± 0.42 P-value 0.2631 0.0001 0.0001 Table 4 Volume 2 | Issue 4/201671 Regular IT -0.21 ± 0.420 -0.21 ± 0.42 P-value 0.34230.00010.0001 P-value 0.26310.00010.0001