Without local anesthesia, the implant is reversed for 3 times with minimal discomfort when torque wrench is set at 60 Ncm.  As expected, the patient suddenly feels that the paresthesia decreases.  Then the torque wrench is set at 50 Ncm; the implant is turned 2 more times. The implant is apparently stable (Fig.3).  It is estimated that the implant has been turned 360 degrees in total.

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Xin Wei, DDS, PhD, MS 1st edition 09/20/2014, last revision 09/21/2014