There’s nothing like finishing a beautiful implant restoration, torquing everything down, sealing the access hole, and sending your patient on their way with a perfect bite and a happy smile.
Fast-forward a few weeks… they’re back.
“It feels a little loose,” they say. And sure enough, that implant crown you were so proud of is rocking like a loose tooth.
Sound familiar?
If you’ve been in the lab or clinic long enough, you’ve probably run into this more than once. And chances are, the culprit wasn’t a bad restoration or even a tricky occlusion. It was something deceptively simple:
The screw wasn’t re-torqued.
Let’s talk about what re-torquing is, why it matters more than most people realize, and when you should be doing it to avoid the dreaded “loose screw” call.
What Is Re-Torquing?
Re-torquing just means tightening the prosthetic screw again, shortly after you’ve already torqued it once. Usually, you’ll torque the screw to the manufacturer’s recommended value, wait about 5 to 10 minutes, and then torque it again.
You might be thinking, “Why would I do it twice? Isn’t once enough?”
Well, not exactly. That short wait allows for something called settling to happen – and it’s more important than it sounds.
Let’s Talk About Settling (The Invisible Slack)
When you first torque a screw into place, everything feels solid. But on a microscopic level, the surfaces between the screw, abutment, and implant aren’t perfectly smooth. They compress and shift slightly under pressure – kind of like how your mattress settles after the first few nights.
This settling effect causes a loss of preload, which is the tension in the screw that keeps everything snug. If you don’t retighten after settling, that tension can drop enough to let the screw start moving under load.
What happens next?
- Micromovement under function
- Screw loosening
- Access hole fracture or material chipping
- Patient returns with “something feels off”
And yes, sometimes even a full restoration coming off mid-bite.
When Should You Re-Torque?
The good news? Preventing this is incredibly easy. You just have to build re-torquing into your workflow. Here’s where it fits best:
🕒 After Final Torque at Delivery
After your initial torque (say, 30 Ncm), take a short break. Let the patient relax, check occlusion again, or start cleanup. Then come back in 5 to 10 minutes and re-torque to the same value.
This resets the preload after any settling and gives you a more stable connection.
📆 At the First Follow-Up Appointment
Some clinicians schedule a check-in 1 to 2 weeks later, especially for full-arch or multi-unit cases. This gives you a second opportunity to confirm everything is holding strong.
🪥 During Maintenance Appointments
Hygiene visits are the perfect time to check torque – especially if the patient reports even a hint of looseness or discomfort. A quick re-torque now can prevent a full-blown failure later.
What Tools Should You Use?
Always use a calibrated torque wrench. Eyeballing with a hand driver? That’s a recipe for inconsistency (and wrist pain).
Different implant systems recommend different torque values – typically between 15 to 35 Ncm. Check the specs for the exact screw and component you’re working with, and don’t mix and match components unless you’re absolutely sure they’re designed to work together.
Also, make sure the screw and internal threads are clean and dry. Saliva, blood, or lubricant residue can throw off torque values and cause early loosening.
What Happens If You Don’t Re-Torque?
Skipping re-torqueing may not show immediate consequences, but over time it leads to:
- Screws backing out under normal chewing
- Movement that affects fit and occlusion
- Broken crowns or chipped ceramics
- In full-arch cases, one loose screw can destabilize the entire prosthesis
Think of re-torquing as insurance: small step = big reward.
Quick Tips to Make Re-Torquing Easy
- ✅ Set a timer right after you first torque. Five to ten minutes is all you need.
- ✅ Use a clean driver – no gunk, no guesswork.
- ✅ Mark re-torque in your chart so no one forgets.
- ✅ Train the team to build it into every implant workflow, every time.
Final Thoughts
In implant dentistry, it’s the little things that set the great results apart from the good ones. Re-torquing might seem small, but it’s one of those little habits that adds years to the life of a restoration – and saves you from one of those awkward “um… it came off” phone calls.
So next time you torque down a case, don’t walk away just yet.
Set your timer. Smile. And give it that second click.
Your implants (and your patients) will thank you for it.
