Do I really need a bone graft?

• Socket graft (D7953): placed right after a tooth is pulled, to limit the shrinking. Research shows it keeps more bone than letting the socket heal on its own.
• Graft at the time of the implant (D6104): adds bone around the implant as it's placed, when a small area is thin.
• Sinus lift (D7951, D7952): for upper back teeth, where the sinus sits just above the roots and there may not be enough height for an implant.
• Larger grafts to rebuild bone that has been missing for a long time.

Small grafts can often be done at the same visit as the implant. Larger ones usually need several months to heal (often four to six) before the implant goes in. For how timing works after a tooth is removed, see Can the implant go in the same day my tooth comes out?

Graft material can come from a few places, and all are commonly used:

• Your own bone, usually taken from nearby in the jaw
• Donor bone from a human tissue bank, cleaned and processed
• Animal bone, most often from cows, processed so only the mineral is left
• Synthetic (man-made) material

A thin covering called a membrane is often placed over the graft, and some membranes come from animal tissue. If you'd rather avoid donor or animal products for religious, dietary, or personal reasons, say so before treatment. There are usually other options.

• You plan to get an implant later, and the tooth is being removed now.
• The tooth has been missing a while, and the bone has thinned.
• A front tooth, where bone loss can affect how the gum and implant look.
• Upper back teeth with little height under the sinus.

• You're not planning an implant for that spot. A socket graft is mainly to keep bone for an implant. It can still help in some cases, such as under a bridge in a front-tooth spot, where keeping the bone and gum full helps the false tooth look natural. If you plan a bridge, a partial denture, or to leave the space, ask what the graft would add for you.
• There's already plenty of bone, as shown on a 3D X-ray.

Ask to see the X-ray or 3D scan and where the bone is thin. A 3D scan (cone-beam CT) shows bone width and height in a way a regular X-ray can't.

Plans handle grafts differently. Some cover them when they cover the implant, some cover only certain types, and some don't cover them at all. Ask for the graft to be included in the predetermination, so you see it before treatment.