Effect of viewing angles on measurement errors when using an implant cantilever beam torque-limiting device

Abstract

Statement of problemImplant cantilever beam torque-limiting devices are affected by parallax, which may result in measurement read error. The overread or underread of the true target torque value could lead to premature failure of the screw joint of a dental implant. PurposeThe purpose of this in vitro study was to determine the effect of the operator’s viewing angle relative to the cantilever beam and measurement reading scale when the torque-limiting device is actioned toward or away from the operator. Material and methodsA beam torque wrench (Nobel Biocare USA) was used with the cantilever beam position fixed by using a wedge to read 32 Ncm on the marker arm. It was suspended in a vertical position relative to a digital single-lens reflex camera set at a fixed distance of 48 cm from the marker reading. The camera was rotated in 10-degree increments clockwise and counterclockwise relative to the cantilever beam reading, starting perpendicular to the marker. Photographs were recorded at each angle. Percentage measurement read error was calculated from dimensions of the cantilever beam torque device, including the beam diameter, distance from the marker arm, and the incremental marks on the measurement scale. Data were analyzed descriptively to determine the differences after comparison with the International Organization for Standardization (ISO) 6789-1:2017 recommendations. ResultsPhotographs compared beam position relative to the 32-Ncm marker. The beam diameter was recorded as 1.5 mm, corresponding to approximately 5 Ncm. The distance between the marker arm and center of the beam was 0.08 mm. Percentage errors were greatest at lower torque values and increased relative to the viewing angle. Photographs showed that instrument overread was most likely to occur as the beam was moved away from the operator, which would result in potential undertightening unless compensated for. Underread was noted when the beam was pulled toward the operator. ConclusionsTo prevent measurement read error when using an implant cantilever beam torque-limiting device, the operator should be positioned as close to a perpendicular viewing angle to the cantilever beam as possible. Viewing from an angle greater than 10 degrees from the perpendicular should be avoided for torque values less than 15 Ncm. For screws tightened between 25 Ncm and 35 Ncm, the viewing angle should be less than 30 degrees so that the applied torque is within the maximum deviation of the target torque value set by the ISO 6789-1:2017 recommendations.