While dental implants have become increasingly important in the functional and esthetic rehabilitation of patients, implant failure still does occur. Primary stability at the time of implant placement and the development of osseointegration in the following healing process (secondary stability) are essential parameters for implant success [1]. Primary stability can be considered as the biomechanical stability that holds the implant in place. It is highest immediately after insertion and decreases with time [2]. Primary stability is achieved by the mechanical retention of the implant and is dependent on the design and thread geometry of the fixture. With sufficient implant stability, a shortened healing time and immediate implant function is possible [3]. Primary stability is influenced by the quality and quantity of bone present [4]. In compact cortical bone, it is achieved more frequently than in spongious bone, due to reduced bone density when trabeculae are present [5]. Implant length, diameter, geometry, surface characteristics, insertion technique, and congruence between the drilling site and the implant size [6] are reported as additional influencing factors. Furthermore, the stability of the implant plays a crucial role in the clinical follow-up and control of the degree of osseointegration after implant insertion. Various assessment protocols have been proposed for determining primary implant stability. Subjective methods, such as the surgeon's individual assessment or percussion testing, have little significance, and cannot be reproduced predictably [5, 7]. Objective tests include Periotest® measurements [8,9,10], the assessment of insertion torque [8, 9, 11], the experimental removal of the implant [12], or a resonance frequency analysis (RFA) [9,10,11]. RFA was first described by Merideth in 1996 [13]. Modern RFA devices such as the Osstell device (W & H Dentalwerk, Bürmoos GmbH, Austria) can calibrate the raw frequencies for the selected implant system with implant-specific transducers (Smartpegs, W & H Dentalwerk, Bürrmoos GmbH, Austria) and convert them into implant stability quotients (ISQ). According to the manufacturer’s instructions, smartpegs are manually inserted into the implant by means of a plastic insertion aid [14]. The scale of ISQ values ranges from 0 to 100%, with stability increasing with increasing ISQ. The values are not linearly distributed but correspond to a low stability at values below 60, a medium stability at values between 60 and 69, and a high stability at values above 70 [15]. ISQ values at the same implant may clinically differ, depending on which direction is measured. It is therefore recommended that two measurements are carried out from orthogonal directions. It has been controversially discussed whether the individual finger pressure of different examiners may show alterations of ISQ values when hand tightening the smartpegs. A recent in vitro study by Geckili et al. indicated that the manual insertion torque of smartpeg transducer with a plastic driver can have an influence on the results determined [16]. Consequently, the authors recommended the manufacturer to standardize the tightening of smartpegs to a range of 5–8 Ncm to obtain reliable and objective RFA values, instead of leaving it to subjective finger pressure. As there is only limited in vivo or ex vivo data available to confirm or refute these results, the aim of the current study was to assess whether or not the insertion torque of a smartpeg transducer influences the ISQ values identified. The null hypothesis was that the manual tightening force of a smartpeg device has an impact on the resulting ISQ values during resonance frequency analysis.