Implant Dentistry

Bone Grafting for Dental Implants: Do You Need One, and Does It Work?

October 13, 2026

Medically Reviewed by Dr. Elizabeta Cokovska

Few people expect to hear the words “bone graft” at an implant consultation. They came in about a missing tooth, and now there is a second procedure on the plan. The natural question is whether it is really necessary, or whether it is an extra being added to the bill.

The short answer: A bone graft rebuilds jawbone where there is not enough to hold an implant securely. Bone shrinks quickly after a tooth is lost: within six months, the ridge typically loses 29% to 63% of its width and 11% to 22% of its height (source). Grafting either preserves the socket when a tooth is removed or rebuilds bone later, and implants placed in grafted bone have high survival rates. Whether you need one is decided by a 3D scan, not by a standard plan.

Why Bone Goes Missing

A tooth root keeps the bone around it in use. Once the root is gone, the body starts to reabsorb that bone, and most of the change happens in the first few months. The ridge narrows more than it shortens, which is why width is usually the first problem for an implant.

Other common causes are years of wearing a denture, which rests on the ridge without loading it, advanced gum disease, infection around a failing tooth, and in the upper back jaw, the sinus expanding downward into space the tooth roots used to occupy.

The Main Types of Bone Graft

Socket preservation fills the socket with graft material when a tooth is removed, to limit the shrinkage that would otherwise follow.
Ridge augmentation rebuilds width or height in a ridge that has already shrunk, often months or years after the tooth was lost.
Sinus lift (sinus floor elevation) raises the floor of the sinus and adds bone beneath it, so implants can be placed in the upper back jaw.

The graft material can be your own bone, processed donor bone, animal-derived bone mineral, or a synthetic substitute. Each acts as a scaffold your own bone grows into and gradually replaces. All three procedures are performed at our practice.

What the Evidence Actually Says

Socket preservation works. A systematic review of randomized trials found that filling the socket with graft material limits ridge loss compared with extraction alone (source). A later meta-analysis put the difference at about 1.86 mm of preserved width (source). That sounds small, but on a ridge only a few millimeters wide it can decide whether an implant fits without a second graft.

Implants in grafted bone do well. A systematic review of 48 studies and 12,020 implants placed with sinus lifts found the best results, using modern rough-surface implants with a membrane over the graft, reached 98.3% implant survival after three years (source). A companion review of the less invasive sinus technique, done through the implant site itself, found survival comparable to implants in bone that needed no grafting (source).

The Part Most Articles Leave Out

Not everyone needs a graft. A 3D scan shows exactly how much bone there is and where. Sometimes a shorter or narrower implant fits safely. In full-arch treatment, techniques such as All-on-4 angle the back implants to use the bone that is already there, which can avoid grafting altogether in some cases.

The headline numbers are per implant, not per person. In the same sinus lift review, overall implant survival was 90.1% at three years, and when results were counted per patient rather than per implant, about one in six patients lost at least one implant in that time. Results have improved with better implants and techniques, but a grafted site still deserves careful planning and an honest conversation about risk.

Grafting adds time. A graft usually needs to heal before an implant goes in, which can add several months. Small grafts can often be placed at the same visit as the implant. Which applies to you should be clear before treatment starts.

How Long It Takes

Socket preservation happens at the same appointment as the extraction. Healing before an implant is placed commonly takes a few months, often three to six, depending on the size of the graft and where it is. When a graft is small and the implant can be stabilized in existing bone, both can often be done together, with no extra healing period.

What Recovery Is Like

Most people describe recovery from a small graft as similar to having a tooth removed: some swelling and tenderness for a few days, eased with over-the-counter pain relief and a soft diet. Larger grafts and sinus lifts take longer to settle. Sedation is available for any grafting procedure, and you receive written aftercare instructions before you go home.

What It Costs

Grafting is priced as part of the overall implant plan, and the cost depends on the type and size of the graft. We do not quote a figure without a scan. After your consultation you receive a written estimate listing every stage, including any grafting, so nothing is added later. For national averages on implant treatment, see how much do dental implants cost.

How It Works at Our Practice

Dr. Elizabeta Cokovska performs socket preservation, ridge augmentation and sinus lifts here, so the graft and the implant are planned and placed by the same clinician, without a referral to a separate surgeon. Every case is planned on a 3D scan, which shows whether there is enough bone before anything is scheduled.

Where bone and infection allow, a failing tooth can be removed and the implant placed at the same visit, as described on our same-day extraction and implant page. Where they do not, we graft first and explain why, because forcing an implant into bone that cannot support it is one of the most common reasons implants fail.

Patient before bone grafting and implant treatment — Before: a patient treated at our practice.

The same patient smiling after bone grafting, implants, an upper arch restoration and veneers — After: the same patient following bone grafting, then implants, an upper arch restoration and veneers, all planned and completed at our practice. Individual results vary.

What to Ask Any Practice

How much bone do I have, and can you show me on the scan?
Is a graft essential, or are there options that avoid it?
What type of graft, and what material?
Will the graft and implant be done together or in stages?
Who does the graft, and is it the same person who places the implant?
Is grafting included in the written estimate?

Final Takeaways

After an extraction, the ridge typically loses 29% to 63% of its width and 11% to 22% of its height within six months.
Socket preservation at the time of extraction limits that loss, by about 1.86 mm of width in one meta-analysis.
Implants in grafted bone have high survival rates, up to 98.3% at three years after sinus lifts with modern techniques.
Not everyone needs a graft; a 3D scan decides, and some techniques avoid grafting altogether.
Grafting can add several months, although small grafts are often done at the same visit as the implant.
Ask for any grafting to be listed in your written estimate before treatment begins.

Research References

Tan WL, Wong TL, Wong MC, Lang NP. A systematic review of post-extractional alveolar hard and soft tissue dimensional changes in humans. Clin Oral Implants Res. 2012;23 Suppl 5:1–21. repository
Avila-Ortiz G, Elangovan S, Kramer KW, Blanchette D, Dawson DV. Effect of alveolar ridge preservation after tooth extraction: a systematic review and meta-analysis. J Dent Res. 2014;93(10):950–958. PMC
Bassir SH, Alhareky M, Wangsrimongkol B, Jia Y, Karimbux N. Systematic review and meta-analysis of hard tissue outcomes of alveolar ridge preservation. Int J Oral Maxillofac Implants. 2018. quintessence
Pjetursson BE, Tan WC, Zwahlen M, Lang NP. A systematic review of the success of sinus floor elevation and survival of implants inserted in combination with sinus floor elevation. J Clin Periodontol. 2008;35(8 Suppl):216–240. pubmed
Tan WC, Lang NP, Zwahlen M, Pjetursson BE. A systematic review of the success of sinus floor elevation and survival of implants inserted in combination with sinus floor elevation. Part II: transalveolar technique. J Clin Periodontol. 2008;35(8 Suppl):241–254. repository

Where to Go From Here

Makris Dental Prosthodontics is a specialty prosthodontic practice at 13250 Narcoossee Rd #103 in Lake Nona Medical City, Orlando. Dr. Elizabeta Cokovska is a board-certified prosthodontist with over 30 years in practice.

Start with dental implants for an overview, read how long dental implants last, or see more before and after results. If you have been told you are not a candidate for implants because of bone loss, a second opinion with a 3D scan is worth having.

Call (407) 753-4743 or request a consultation online. You will leave the first visit with a written assessment either way.

FAQs

What is a bone graft for dental implants?

A bone graft rebuilds jawbone where there is not enough to hold an implant securely. Graft material acts as a scaffold that your own bone grows into and gradually replaces. It can be done when a tooth is removed, to preserve the socket, or later, to rebuild a ridge that has already shrunk.

Do I need a bone graft to get implants?

Not always. A 3D scan shows exactly how much bone there is. Sometimes a shorter or narrower implant fits safely, and in full-arch treatment, techniques such as All-on-4 angle the back implants to use existing bone, which can avoid grafting in some cases.

Why do I not have enough bone for an implant?

Bone shrinks quickly once a tooth is gone. A systematic review found the ridge typically loses 29% to 63% of its width and 11% to 22% of its height within six months of an extraction. Years of denture wear, gum disease, infection and sinus expansion also reduce bone.

What are the different types of bone graft?

Socket preservation fills the socket with graft material at the time of extraction to limit shrinkage. Ridge augmentation rebuilds width or height in a ridge that has already shrunk. A sinus lift raises the sinus floor and adds bone beneath it so implants can be placed in the upper back jaw. All three are performed at our practice.

Does socket preservation actually work?

Yes. A systematic review of randomized trials found socket preservation limits ridge loss compared with extraction alone, and a later meta-analysis put the benefit at about 1.86 mm of preserved width. On a narrow ridge, that can decide whether an implant fits without a second graft.

Do implants in grafted bone last?

Generally, yes. A review of 12,020 implants placed with sinus lifts found the best results, with modern implants and techniques, reached 98.3% survival at three years. A review of the less invasive sinus technique found survival comparable to implants in ungrafted bone.

How long does a bone graft take to heal?

Healing commonly takes a few months, often three to six, depending on the size and location of the graft. Socket preservation is done at the same visit as the extraction, and small grafts can often be placed at the same visit as the implant, with no extra healing period.

Is bone grafting painful?

Most people find a small graft similar to having a tooth removed: some swelling and tenderness for a few days, eased with over-the-counter pain relief. Larger grafts and sinus lifts take longer to settle. Sedation is available, and you receive written aftercare instructions.

How much does a bone graft cost?

It depends on the type and size of the graft, so we do not quote a figure without a scan. Grafting is priced as part of the overall implant plan, and any graft is listed in your written estimate before treatment begins, so nothing is added later.

How do I find out if I need a bone graft?

With a consultation and a 3D scan, which show how much bone you have and where. From those you receive a written plan explaining whether a graft is needed, what type, how long it adds, and the full cost, before anything is scheduled.

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