A dental implant is an artificial tooth root placed in the jawbone, so the bone has to be there to hold it. When a tooth has been missing for a while, or the bone has been damaged by gum disease or injury, there may not be enough bone for an implant. That is where bone grafting comes in. This guide explains why bone is lost, the main grafting procedures, how they fit into implant treatment, and the questions to ask.
Why bone matters for implants
The FDA describes an implant body that is surgically inserted into the jawbone in place of the tooth root (FDA: Dental implants). The American Academy of Periodontology (AAP) says an ideal implant candidate has adequate bone in the jaw to support the implant, along with good general and oral health and healthy gums (AAP: Dental implant procedures). The American Association of Oral and Maxillofacial Surgeons (AAOMS) adds that implants require sufficient bone mass and density to provide a stable base (AAOMS: Preserving bone for dental implants).
Implants are made of titanium alloy that fuses with the jawbone through a process called osseointegration, which AAOMS says usually takes several months.
Why bone is lost
- Tooth loss or extraction. AAOMS explains that natural teeth stimulate the bone and help maintain its volume, and that after a tooth is lost or extracted, the bone that supported it can deteriorate or be resorbed.
- Gum disease. Periodontal disease destroys the bone that supports teeth. AAOMS notes that bone loss is common in people who have lost teeth or had periodontal disease.
- Anatomy. The AAP notes the upper back jaw has traditionally been one of the most difficult areas for implants because of limited bone and the nearby sinus.
- Injury. Trauma can damage teeth and bone.
Bone loss can also affect neighboring teeth and your appearance. AAOMS says adjacent teeth may shift into a gap and the area can look sunken.
Types of grafting procedures
Socket preservation
Done at the time of an extraction, socket preservation aims to maintain the bone’s natural structure and contours after the tooth is removed. AAOMS recommends that anyone planning an extraction talk with an oral and maxillofacial surgeon about bone and socket preservation options. If you are facing an extraction, our guide to tooth extraction cost and recovery covers the procedure itself.
Ridge augmentation or modification
When the jaw ridge is too thin or short, the AAP describes lifting the gum away from the ridge and filling the void with bone or bone substitute to build it up. The AAP says ridge modification has been shown to greatly improve the jaw’s appearance and increase the chances of successful implants. The AAP also describes ridge augmentation as a way to fill the indentation that can form after tooth loss.
Sinus augmentation (sinus lift)
For the upper back jaw, the AAP describes sinus augmentation as raising the sinus floor and developing bone for implant placement.
Regenerative procedures for gum disease
Where bone supporting natural teeth has been destroyed by periodontal disease, the AAP says periodontists may use membranes, bone grafts or tissue-stimulating proteins to encourage the body to regenerate bone and tissue (AAP: Surgical procedures).
How grafting fits into implant treatment
Every plan is individual, but implant treatment with grafting often involves these stages:
- Evaluation. An exam, medical history and imaging. A 3D cone beam CT scan is often used for implant planning; our dental X-rays guide explains it.
- Grafting. Sometimes done at extraction, sometimes as a separate procedure, and sometimes at the same time as implant placement.
- Healing. The graft needs time to integrate before or while the implant heals.
- Implant placement and osseointegration. AAOMS says this usually takes several months; the FDA notes healing may take several months or longer.
- Restoration. The crown, bridge or denture is attached.
Your surgeon will tell you which steps apply and the expected timeline for your case.
Who does bone grafting?
Oral and maxillofacial surgeons and periodontists commonly perform grafting and implant surgery. AAOMS emphasizes that implant surgery is surgery and best performed by a trained surgeon; the AAP notes periodontists have three years of specialty training after dental school focused on gums and bone. Our overview of dental specialists explains the difference.
Risk factors that affect healing
- Smoking. The FDA says smoking may affect healing and decrease the long-term success of an implant. AAOMS says smoking lowers implant success rates but does not rule out implants.
- Medical conditions. AAOMS says patients with most chronic diseases, such as high blood pressure and diabetes, are usually successful implant candidates, though precautions may be needed. See our article on diabetes and oral health.
- Age. AAOMS says implants in children are usually deferred until jaw growth is complete.
Cost
We do not quote prices for grafting because it varies by the type and amount of graft, the material and the region. A graft is usually a separate line item from the implant itself. Ask for an itemized estimate; our guides to reading a treatment plan and implant vs. denture cost factors can help you compare options.
Questions to ask your surgeon
- Why do I need a graft, and what will happen if I skip it?
- What type of graft and material do you recommend?
- Will the graft and implant be done at the same time or separately?
- What is the expected healing time before the next step?
- What brand and model of implant will be used? (The FDA suggests keeping this for your records.)
Key takeaways
- Implants need enough healthy jawbone; when it is missing, grafting can rebuild it.
- Bone shrinks after tooth loss, so socket preservation at extraction can help.
- Ridge augmentation and sinus lifts are common grafting procedures before implants.
- Smoking can affect healing and long-term implant success.
Bring a list of your medicines and health conditions to your consultation, and ask the surgeon to explain your imaging so you can see where bone is missing.
Frequently asked questions
Does everyone need a bone graft before an implant?
No. It depends on how much healthy bone you have where the implant will go.
Can I get an implant if I have bone loss?
Often, yes. AAOMS says surgeons are trained in grafting to add bone and safely secure implants.
Why would a dentist graft right after an extraction?
To preserve the bone that would otherwise shrink after the tooth is gone, which AAOMS says can make future implants and dentures more successful and predictable.
How long does it take?
Timelines vary. Implants themselves need several months to integrate with bone, and grafts add healing time. Your surgeon can give a timeline for your case.
Are there alternatives to grafting?
Depending on your situation, a bridge or denture may not require grafting. Our comparison of implants vs. bridges vs. dentures explains the trade-offs.
Sources
- AAOMS: Preserving Bone for Dental Implants and Oral Health
- AAOMS: Are You a Candidate for Dental Implants?
- American Academy of Periodontology: Dental Implant Procedures
- American Academy of Periodontology: Surgical Procedures
- FDA: Dental Implants: What You Should Know
By the Dentist Review Editorial Team.
This article is for general information only and is not medical advice. Talk to a licensed dentist about your own situation. See our disclaimer.
Featured image: “Implant overdenture model” by Coronation Dental Specialty Group, via Wikimedia Commons, licensed CC BY-SA 3.0. Resized and compressed for the web.
Our guides are written and reviewed by the Dentist Review editorial team. We research each topic using public, authoritative sources such as the CDC, the National Institutes of Health (NIH/NIDCR), the American Dental Association (ADA) and CMS, and we update guides when guidance changes. Guides are for general information only and are not dental or medical advice; please read our disclaimer and learn more about us.