Getting dental implants can be a great way to replace missing teeth and restore your smile. However, in some cases, patients may wonder if they can get an implant without having a bone graft first. There are a few key factors that determine whether a bone graft is necessary before placing an implant.
What is a bone graft?
A bone graft is a surgical procedure that places new bone material in the jaw to augment or build up bone volume. There are a few reasons why a bone graft may be recommended before getting an implant:
- To fill in areas where bone has been lost due to extraction, gum disease, or trauma
- To increase vertical bone height if the jawbone is too short for implant placement
- To improve bone density if the existing bone is too soft or porous
The bone used in a graft can come from your own body (autogenous bone), from a bone bank (allograft bone), or it can be synthetic. The graft creates a platform of dense, viable bone into which the implant can be placed.
When is a bone graft necessary?
In general, a bone graft is needed when the existing jawbone is not thick or tall enough to securely integrate with the implant. Each implant must be surrounded by 2-3 millimeters of bone on all sides for optimal stability and integration. If this bone is lacking, a graft can build it up prior to placement.
Some common scenarios where bone grafts are required include:
- You need an implant placed where a tooth was extracted within the past 6-12 months. The bone may still be healing and need grafting.
- You have moderate to severe gum disease or periodontal disease. This can destroy bone around teeth over time.
- You need an implant placed in the upper back part of the jaw. This area often lacks adequate vertical bone height.
- You’ve been edentulous (missing all teeth) for many years. Long-term edentulism leads to bone loss in the jaws.
- You need to place an implant immediately after extracting a failing tooth. The socket will require grafting.
Your dentist will assess the health of your jawbone using x-rays, CT scans, and clinical evaluation during your exam. If inadequate bone is present, a graft can address this first.
When can an implant be placed without a bone graft?
Under certain circumstances, you may be able to get an implant without a preliminary bone graft if your jawbone is healthy and sufficient:
- You have good width and density of bone. If you have no signs of bone loss and have maintained continuous tooth stimulation through remaining teeth or dentures, you may have adequate bone.
- Only one tooth needs to be replaced. Single tooth gaps are less likely to have significant bone loss than larger edentulous spans.
- You lost the tooth very recently. If tooth extraction was done gently with bone preserving techniques, the socket may heal well on its own.
- You want the implant placed in your lower jaw. The lower jaw tends to maintain its bone density better than the upper jaw.
- You opt for a smaller diameter implant. A narrower implant requires less bone width.
- You are willing to undergo localized bone expansion. Small amounts of bone can be added as the implant is placed.
Your dentist will take impressions, obtain scans, and use clinical evaluation to determine if your bone is adequate for immediate implant placement without grafting. If you have any risk factors like gum disease, long-term missing teeth, or thin jaw structure, a graft may still be recommended.
The implant procedure without a bone graft
If you are approved to get an implant without a preliminary bone graft, the procedure will be streamlined. Here is what you can expect:
- Numbing. The area around the implant site will be numbed with local anesthesia.
- Incision. A small incision is made in the gums to access the bone.
- Osteotomy. A precision drill is used to create a cylindrical socket in the jawbone for the implant.
- Placement. The implant is carefully tapped or screwed into position in the bone.
- Healing cap. A protective cover is placed over the implant while the bone integrates (osseointegrates) with the implant surface.
- Sutures. The incision is closed with stitches that resorb on their own.
- Healing. The implant integrates with the jaw over 3-6 months before restorative work begins.
Proper oral hygiene and care of the implant site during initial healing is crucial for optimal results.
Advantages of skipping the bone graft
Getting an implant without a bone graft offers a few advantages:
- Fewer procedures. Skipping grafting surgery means less treatment time, discomfort and recovery.
- Lower cost. Not needing a separate graft surgery makes the process more affordable.
- Quicker implant placement. Grafting adds 3-12 months before the implant can be placed.
- Greater comfort. One less surgery means less post-op swelling and disruption.
However, only certain patients are candidates for this streamlined approach. Adequate bone volume and density are prerequisites.
Risks and disadvantages
Placing an implant without first performing a needed bone graft does carry some drawbacks and risks:
- The implant may fail early on due to lack of bone support.
- The implant may develop mobility or shifting over time as bone recedes.
- Surrounding teeth roots may be damaged during implant drilling.
- The final restoration may appear sunken or uneven once placed.
- Infection is more likely with poor bone density.
- The implant procedure takes longer trying to expand thin bone.
Skipping a recommended graft solely to save time or money may result in poorer implant outcomes. Your dentist will advise you based on your unique case.
Options if you need a bone graft
Don’t worry if you do need a preliminary bone graft before getting your implant. Here are some options to consider:
- Sinus lift: grafts bone in the upper jaw sinus cavity to increase vertical height
- Ridge expansion: makes bone wider by splitting or tenting the ridge
- Socket preservation: grafts a fresh extraction socket to maintain bone
- Block graft: uses a solid piece of bone to rebuild lost bone
- Guided bone regeneration: regenerates bone using barrier membranes
- Distraction osteogenesis: uses devices to gradually expand bone
Your dentist will recommend the most suitable grafting technique for your needs. While grafting does require extra time, it helps ensure your implant has the strongest foundation possible for long-term function and health.
Talk to your dentist
The need for bone grafting before dental implants depends on each patient’s unique clinical situation. Factors like your oral health history, bone quality in the implant site, and the number of teeth being replaced all play a role.
Have an open discussion with your dentist regarding the state of your jawbone health. Together, you can determine whether grafting is recommended or if you may be a candidate to skip this extra procedure. With proper planning and care, you’ll be on your way to a successful implant supported restoration.
| Scenario | Bone Graft Needed? |
|---|---|
| Tooth extracted 1 month ago | Probably |
| Moderate gum disease present | Likely |
| Upper back jaw placement | Very likely |
| No history of bone loss | Possibly not |
| Immediate implant after extraction | Yes |
The takeaway
While getting an implant without a bone graft may be possible in select cases, your dentist’s recommendation is key. Do not skip a needed graft solely due to cost or convenience. Adequate bone support is essential for long-term implant success and stability.