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Dental Implant Bone Grafting –Do I Need It?

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?

13 thoughts on “Dental Implant Bone Grafting –Do I Need It?

  1. Can a general dentist perform bone grafts? Is it a core privilege or a special privilege? What kind of training is required?

    1. 100% without question a general dentist can perform a bone graft. Some general dentists perform bone grafts better than oral surgeons and periodontists! On the other spectrum some regular dentist and specialists are absolutely terrible at it and should not be doing it! It really comes down to the training, experience, judgment and skill of your particular dentist. I do not suggest you see somebody who does dabble some this type of treatment but rather this is their focus.
      I would suggest you see somebody who is been credentialed by the American board of oral Implantology if you’re looking for somebody who is well trained. This is a validation that they are expert in the field.

  2. I had the Canine and upper four tooth removed after they abscessed. The specialist spoke about a bone graft ,but then closely inspected x rays and informed me that we should be able to do the implant without the graft . It’s within the acceptable area when he placed the overlay chart over the top he explained. I’m happy to not have to have the extra surgery but I’m worried about the increased risk of failure and or nerve interference…Should I question his judgement. Actually it is a government dental hospital for students.

    1. The upper canine tooth and upper front teeth are definitely complex dental implant replacements. They almost always need some type of a bone graft especially in the canine area.

      Skimping on a bone graft will make the outer wall of your bone very thin and susceptible to bone loss in just a few short years.

      Reinforcement bone grafting to thicken this outer wall is very important. As a dental implant specialist, I see many implant complications that could have been avoided by engineering things properly. Saving money now will only cost you a tremendous amount more in the future.

  3. I have had bone grafting with titanium implants..many.
    Now I see receeding gums on both upper sides and can see the implant posts. I am pretty terrified as my insurance will not cover dental. I am SS and part time working older woman. Credit not bad but not really anything of value available. This sounds like a massive expensive undertaking. I doubt credit care would cover enough. Do not want to waste your time if I cannot pay. Implants by Dr Dennis Smiler around 19 years ago. With sinus implant. Very very worried. Implants LOOK beautiful.thank you for your time.

    1. After 19 years, some recession may be considered normal. My guess is the type of implants you have were “non-coated or surface treated.” These types of machined implants can have bone loss especially in someone that has a thin gum and bone genetic predilection. This is less common with newer dental implants especially placed with a thick outer wall of bone or even placed by computer guidance. If the implants are stable after 19 years, I guess is nothing needs to be done unless it is cosmetic.

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

  4. I had a bone graft done there a big of discomfort but not alot of pain. I need to prepare dental implants. For me it was the right choice. But I also went to a second opinion to compare notes. I am glad I did. Have a great week everybody!

  5. good morning,
    please tell me if a dental implant can be done at the same visit or within a couple of weeks of a bone graft?
    or does the bone graft have to heal for months before an implant is put in place?
    how can one tell if a bone graft has been put in place?
    thanks in advance.

    1. Hi Ann,

      Generally a bone graft would take much longer than two weeks to heal. It seems a bit odd. There is probably a miscommunication.

      Not all types of bone grafts can be seen on xray. In fact most cannot.

      Synthetic materials and cow bone are more easily visible than bone from a human cadaver.

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

  6. I’m grateful to you for this excellent website. Can you recommend or tell me how to find a dentist like you 🙂 located in the Chicago, IL area?

    1. Thank you for your kind words. Look on the AAID or ABOI website for someone with the same credentials.

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

  7. Hi Dr. Ramsey Amin,
    You did my implants and bone graft 10 years ago! I moved to Tuscon.
    My dentist said your work is awesome and is holding up perfectly!
    Thank you!!!!!!!!!!!

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About Ramsey A. Amin, DDS

Dr. Ramsey Amin has extensive experience in surgical and restorative implant dentistry. As one of only less than 400 Diplomates of the American Board of Oral Implantology/ Implant Dentistry (ABOI/ID) he is considered an expert, and board-certified in dental implants. He is a former instructor at the UCLA School of Dentistry.