This is one of the most common questions I get.
Some of the implant “supercenters” advertise that it is not necessary. Unfortunately that marketing is misleading. It is a case-by-case situation that needs to be carefully evaluated.
If the bone is not wide or tall enough for an implant, a bone graft is recommended. Sure, an implant can just be “put” in into almost no bone. Is that really helping you? What most fail to understand is that you are compromising on the essential long-term foundation of the implant, which is the surrounding bone.
What if you were constructing a building that was to be secured by four main posts in the ground? If you took out one main post, making the building stand on three legs, it would still stand. If an earthquake happens, would you rather be in the building with four posts or three? Dental implants are no different; they are subject to extreme forces on a daily basis.
Your bite can generate 300 – 500 psi. Not one day goes by, without a patient breaking a tooth. Breaking a tooth involves breaking the enamel, which is the hardest structure in the human body! It is harder than bones! If you can fracture a tooth, you can damage an implant that does not have enough bone.
Once an implant is in place, the most important thing is that the bone level is maintained. If an implant or implant bridge is “under-engineered,” with a lack of bone and/or too few implants, the bone will melt away. Implants that are overloaded are doomed to fail.
Although you may be saving money by avoiding grafting or additional implants, you will pay a steep price in complications as you age. Dental implants should be looked at as a body part. Would you want your heart surgeon to skimp on a valve replacement to save some money?