Possibly, and for older adults it is more common than not. It is also one of the things that catches families off guard, both in terms of timing and cost. Understanding why bone grafting is sometimes necessary, and what it actually involves, makes the whole treatment plan easier to follow.
A dental implant is a titanium post that is surgically placed into the jawbone. For it to integrate successfully and hold a crown or prosthesis long-term, there needs to be sufficient bone, both in height and width, to anchor it. When bone is inadequate, the implant has nothing solid to bond to, and the risk of failure increases significantly.
The reason older adults are more likely to need bone grafting is straightforward. When a tooth is lost, the jawbone that used to support it gradually resorbs, or shrinks, because it no longer receives the stimulation it needs. The longer a tooth has been missing, the more bone loss typically occurs. Someone who lost teeth years ago and has been wearing dentures since may have considerably less bone than someone who lost a tooth recently. Gum disease, which is a common cause of tooth loss in older adults, also destroys supporting bone over time.
Approximately half of all implant cases involve some form of bone grafting, either in advance of placement or at the same time. A thorough evaluation, including three-dimensional CBCT imaging, is the only way to know definitively whether your parent will need it.
The grafting procedure itself is generally less intimidating than it sounds. It is typically performed under local anaesthesia, sometimes with light sedation, and most patients describe the recovery as mild. The graft material, which can be taken from the patient’s own body, sourced from a donor, or made from synthetic or animal-derived materials, is placed into the area where bone is needed and left to integrate. The healing period before an implant can be placed is usually three to six months, depending on the extent of the graft and how quickly the patient heals.
For older adults, healing may take slightly longer than it would for a younger patient. That is worth building into expectations around the overall timeline. It does not, however, mean grafting is inappropriate for older patients. When overall health is stable and the patient is a good surgical candidate, outcomes are generally comparable across age groups.
There are situations where bone grafting can be avoided. If a tooth has only recently been extracted, a socket preservation procedure done at the time of extraction can minimise subsequent bone loss and potentially eliminate the need for grafting later. Modern implant systems, including the angled implant placement used in All-on-4 procedures, are also designed in part to work around areas of bone deficiency, reducing how much grafting is required for full-arch cases.
The families who most often feel blindsided by bone grafting are the ones whose parent received an initial quote for implants, assumed that was the total cost, and then discovered during the detailed treatment planning appointment that grafting added several thousand dollars and several months to the process. Asking upfront, at the very first consultation, whether grafting is likely will save that particular surprise.