Socket Bone Grafting….Do I Need It for My Dental Implant? Ramsey Amin DDS Reviews


Not all extractions need bone grafts for dental implants. A socket bone graft is done at the time of extraction to preserve the bone from shrinking. If the tooth is extracted and left alone, the bone will literally just melt away starting at just a few days after the tooth is removed. The keyword for a socket bone graft is “preservation.” This is called “bone atrophy.”

Let’s review the pros and cons of socket bone grafting:

So how do you know if you need a socket bone graft or not? The most critical zone of the mouth where socket bone grafts are extremely important are all of the front teeth to the middle “bicuspids.”This is because the bone on the outer wall of these teeth is much thinner than it is in the molar region.

Keep in mind there is massive variation from person to person on how thick the outer wall bone is. Your genetics play a huge role here. Some people have naturally thick outer walls of bone and some people have naturally thin bone which does not do well for dental implants.

Bone Graft NOT done

Bone Graft NOT done so her bone was lost

Bone Graft Done

Bone Graft Done (not same patient) –Wide bone

Patients that have thin bone tend to have thin gums too and are easily prone to recession around their teeth and or future dental implants. Patients that have thin bone and thin gums, have to be slightly overengineered in order to have long-term success with dental implants. Bone grafting for a person with a thin bone/gum “biotype” is always necessary. The outer wall of bone has to be designed in such a way that it is more resistant to shrinkage. This can be done by various surgical techniques and by using the right bone material for your particular situation. Not all bone is the same!

When the existing outer bone plate is thin, it is almost a guarantee that the bone is going to collapse as soon as the tooth is removed. This is because the tooth root is supporting that very thin wall of bone. So once the tooth is pulled, the bone collapses in order to close the socket. This leaves you with a depression of bone in that area. Without correction or prevention of that depression in the first place, an implant would have to be placed in a non-ideal position instead of in the center.

So what about the molars… those are the teeth that are extracted the most!! On many occasions the tooth being extracted has had a root canal. It may have abscessed and is painful. When an abscess occurs bone is often naturally dissolved the way on the outer surface. If the tooth being removed too infected, and has thicker bone, a bone graft may not be necessary or advisable at the time of extraction.

Ultimately the decision to do a socket bone graft for dental implant depends on the training, judgment, and experience of performing socket preservation bone grafting on a regular basis. Not only performing the procedure is important, but evaluating its results both on 3-D scan and how the bone feels at the time of implant insertion. And most importantly, how does this bone holdup long-term? I have personal experience of seeing the results of these procedures for the last 15 years as of 2014. The techniques that I use work well and last a long time.

Look for another post coming soon on membranes as that is a common problem area.

Ramsey A. Amin, D.D.S.
Diplomate of the American Board of Oral Implantology /Implant Dentistry
Fellow-American Academy of Implant Dentistry

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5 thoughts on “Socket Bone Grafting….Do I Need It for My Dental Implant? Ramsey Amin DDS Reviews

  1. K Shah

    Hello, I read your blog and impressed with information. I have question regarding my implant procedure going on. My extraction and bone grafting have been done in past Nov2015, now I have to go for implant but my doctor is saying that I am losing some bone but not giving proper explanation for that. Is that ok if I go through implant even though I am losing bone ? Need your advise on this.

    1. RamseyAminDDS Post author

      need more detail on what “loosing bone” means. If you’re just losing surface graft particles that is a completely different story than losing the main part of the bone graft which would support the implant both functionally and cosmetically.

  2. Anonymous

    Hello Dr Ramsey Amin,

    I had an old short post that fractured the root under a crown so opted for an implant on ul5 which was small tooth so had to have the smallest thickness implant to ensure there was room between adjacent teeth to keep the papilla healthy. I am very happy with the appearance of the crown on the implant. My implant was placed over a year ago, 12 weeks after extraction apparently there was plenty of bone and my implant was placed.

    It has been very stable since and looks a great fit on the gum line – there are no black triangles. but I do wonder why there is a slight dint in the gum if I run my fingers over my gum, in comparison to feeling the roots of my adjacent teeth on the other parts of the gum, which pads the gum line out, when I had a socket preservation? I wondered is this normal – or is a socket preservation not meant to preserve where the roots stuck out as such if you have thin gums anyway? All my roots do literally stick out of my gums as I have thin gums. So you can see them and feel them very obviously.

    My dentist put in the powdered bone and a collagen plug and stitches after extraction. Apparently my extraction went seamlessly and the blood stopped quickly etc. I was asked to go back in after a few days and then weekly for monitoring for 8 weeks and everything was fine and three months later my implant went in.

    However on reflection I remember the collagen plug coming out after a day or two (which the dentist knew about as he spotted it). Now I wondered is that dent left in my gum/restructuring of the gum normal with an implant especially for someone who has thin gums with roots that are bulky through them? Or is this because that collagen plug came out, so could have been avoided?

    I have images of my mould so you can see the impression after the implant had been in a few months and where it looks sunken. Also a couple of pics of my gums with a normal picture taken today – I would like to post these however I cant seem to find a way to post them here?

    I would hugely appreciate your advice. Just to put my mind at rest either way :@)

    Thank you

    1. Ramsey Amin DDS

      Yes. I saw your images. It looks like you had a well done procedure overall.

      You did lose a tiny bit of bone due to your thin bone gum bio type. The collagen plug likely had nothing to do with it. The type of bone that was used can prevent this in most cases.

      In thin bone situations, adding more cow bone to the human cadaver bone helps prevent collapse of the bone. It is too late for that, but fortunately you have a near perfect result.

      The root prominence can still be added if you wish. This is usually done with a gum graft. The graft can be cadaver or taken from your palate. It can then be slipped into the deficient area to bulk it up a bit. That tiny bit of bulk makes a big difference in a front tooth.

      You don’t have to do anything also. It is your choice.

      Good luck. Thanks for posting on my blog.

      Dr. Amin.

      1. Anonymous

        Thanks so much for responding and taking the time to look at my images. I really appreciate it :@)

        It’s put my mind at rest as I was worried if it was going to compromise the long term success of the implant having the slight depression from the other teeth by not having the root sticking out.

        It was a putty that was used so I may have got that wrong about it being cow bone but it’s good to know there is an option of gum graft should I ever need it. Sometimes I think when I’m talking it creates like an air bubble /squelch effect maybe against the action of my cheek talking against the depression, which can be distracting at times. However I may get used to this.

        I may post again somewhere else as I have an interesting and large apicoectomy procedure done 20 years ago in my teens after a sporting accident and I’m unsure whether to implant it now or wait to see how long it holds out. I’ve never had problems with it but I was told they don’t last for ever.

        Thanks so much for your help. You’re the best! :@)