BONE GRAFT

Not Enough Bone: Can I Still Get Dental Implants?

Name: I've been told I don't have enough bone. Can I still get implants?
Creator: Ilseop Ahn

Treated by Dr. Ilseop Ahn (board-certified periodontist · specialist in integrated dentistry) · Reviewed by Dr. Ilseop AhnAbout the doctor →

Last reviewed October 29, 2026 · Dr. Ilseop Ahn (board-certified periodontist, specialist in integrated dentistry)

At a glance

Good for: Your jawbone is thin or low, so there is not enough room for an implant
Treatment flow: Measure the shortfall on a 3D CT → Bone graft (same day as placement if needed) → Implant placement → Final crown
Duration and limits: If the bone is built first, the implant is usually placed 4–6 months later, so treatment takes longer

Details

Even if your jawbone is thin or low, implants are often possible once bone grafting creates enough room. If the bone is not wide enough, we do guided bone regeneration, adding bone beside the implant as it is placed. If the bone at an upper molar site is too low below the air space above it (maxillary sinus), we do a sinus lift, raising the floor of the sinus. If enough bone remains, grafting and implant placement are done on the same day; if too little remains, we build the bone first and place the implant usually about 4–6 months later. At Ceramic Dental Clinic, a board-certified periodontist who specialized in jawbone regeneration measures the shortfall in mm on a 3D CT and shows it to you, and the same doctor handles everything from grafting to placement and the final crown.

01^°

Depending on how much bone was missing, the method and order differed

Even "bone grafting" means different work depending on where and how much bone is missing. We show three cases with real X-rays and illustrations.

CASE01

Upper molar with very little bone left below the sinus

Sinus lift (lateral approach) to build bone height first, then implant placement once the bone had filled in

Panoramic X-ray before treatment, enlarged to show the upper right molar site and the maxillary sinus — X-ray before treatment (panoramic). Little bone remained between the upper right molar site and the sinus floor, so it would have been hard to hold an implant firmly as it was.

Panoramic X-ray of the same area 1 week after the sinus floor was raised through a side window and filled with graft material — X-ray 1 week after grafting. A small window was opened on the side of the gum, the sinus floor was raised, and graft material was packed in. A white mass of graft material sits above the sinus floor.

Panoramic X-ray of the same area 4 months after grafting — X-ray 4 months after grafting. The raised height is being maintained. It takes about 5–6 months for graft material to turn into bone, so we decided to check once more with a CT before placing the implant.

Condition: Missing upper molar, about 2mm of remaining bone height
Chosen: Implant placed 6 months after a sinus lift through a side window
Not done: Same-day placement (too little bone remained for good initial stability)
Total duration: 9 months
Note: Even after the implant is placed, the bone at a grafted site must be monitored with regular X-rays.

CASE02

Upper molar with slightly too little bone

Sinus floor raised slightly through the implant hole, with same-day placement

Panoramic X-ray before treatment, enlarged to show the empty upper right first molar site and the maxillary sinus — X-ray before treatment (panoramic). The bone at the upper right first molar site was low because of the sinus and slightly shorter than the implant length. There was still enough to hold the implant when placed.

Periapical X-ray 13 days after placement, showing a rounded dome-shaped graft area above the implant tip — X-ray 13 days after placement. The sinus floor was raised slightly through the implant hole and graft material was added, creating a rounded dome shape above the implant tip.

Periapical X-ray of the same implant 5 and a half months later — X-ray 5 and a half months later. We confirmed that the dome-shaped graft area remained in place and took impressions for the crown.

Condition: Upper molar, about 3mm of remaining bone height
Chosen: Sinus floor raised through the implant site hole, with same-day placement
Not done: Major surgery with a side window (only a small lift was needed)
Duration: About 6 months from placement to crown impressions

CASE03

Thin bone that nearly left the side of the implant exposed

Guided bone regeneration during placement: adding bone to the thin side and covering it with a membrane

Panoramic X-ray on the day of surgery, after an implant was placed at the lower right first molar site — X-ray on the day of surgery (panoramic), right after an implant was placed at the lower right first molar site. On an X-ray, the cheek side and tongue side overlap in one image, so bone "width," the problem in this case, does not show. That is why the surgery is explained with the two illustrations beside it.

Cross-section illustration, cut from the front, showing graft material added to the cheek side of thin jawbone and covered with a barrier membrane and gum — Cross-section of the same site cut from the front. Where the bone was thin and the implant threads on the cheek side were exposed outside the bone, graft material was added (left) and covered with a barrier membrane and gum (right).

Illustration viewed from the cheek side, with graft material wrapped around the front of the implant and covered with a barrier membrane — View from the cheek side. Graft material was wrapped over the exposed threads and covered with a barrier membrane so that gum tissue would not grow into the space where bone should form.

Periapical X-ray of the same implant 2 months after surgery — X-ray 2 months later. The implant had settled, so impressions for the crown were taken that day, and the crown was placed in October 2024. The width of the added bone can only be measured on a CT, so it is not compared in this photo.

Condition: Thin bone, about 4mm wide
Chosen: Implant placement and guided bone regeneration on the same day
Not done: Separate surgery to build bone first (height was enough)
Duration: About 5 months from surgery to crown

* Photos were taken under the same conditions and published with the patients' consent. Treatment results and side effects may vary from person to person.

02^°

Why does jawbone become insufficient?

Depending on the cause, the direction (height or width) and amount of bone loss differ.

01Time has passed since a tooth was removed

The bone that supported a tooth shrinks once the tooth is gone. Width shrinks a lot especially in the first few months after extraction, and the longer the gap is left, the thinner the bone tends to become.

02A tooth was lost to gum disease

Gum disease destroys the bone that supports the teeth, so by the time a tooth is lost, the bone height has often already dropped a lot.

03Long-term denture use

If a denture presses on the gums for a long time, the bone underneath can gradually become lower and thinner.

04Upper molar sites

Above the upper molars is an air space called the maxillary sinus. When a molar is lost, the sinus can drop lower, leaving even less bone height.

03^°

How implants with bone grafting work

Six steps from CT measurement to checkups. We explain what we look at in each step and why, with real clinical photos.

3D CT cross-section with a virtual implant (5mm wide, 8.5mm long) placed at an upper molar site — 3D CT measurement. We place a virtual implant (5mm wide, 8.5mm long) at the planned site and check the remaining bone height and the distance to the sinus, so the shortfall is judged in numbers.

STEP 01

We measure the shortfall in numbers

We measure bone height and width at the planned site with a Vatech 3D CT. To surround a typical implant, a width of usually around 6mm and a height of about 8–10mm makes things easier. If there is less, we show you on screen in which direction and by how much it falls short.

Why we do this"You have no bone" alone does not tell you what needs to be done. The method and duration differ completely depending on whether height or width is lacking, and by how much.

CT cross-section showing the maxillary sinus above an upper molar site and its floor — Sinus check. On a CT cross-section, we look at whether the membrane lining the sinus (dark air space) above the molar site is thickened and swollen, or filled with inflammation.

STEP 02

For upper molars, we check the sinus first

A sinus lift raises the thin membrane on the sinus floor and fills the space beneath it with graft material. If the membrane is thickened and swollen, or there is inflammation such as sinusitis, we first recommend seeing an ENT doctor and postpone the surgery.

Why we do thisOperating on an inflamed sinus can make inflammation worse after surgery or infect the graft material. Checking the membrane before surgery is the surest prevention.

Illustration side by side: enough bone, slightly too little bone raised in a dome shape, and much too little bone grafted through a side window — Choosing the method and order. If there is enough bone, the implant is placed as is. If bone is slightly short, the sinus floor is raised in a dome shape through the implant hole and the implant is placed the same day. If bone is very short, the floor is raised a lot through a side window to build bone first.

STEP 03

We decide whether to do it the same day or build bone first

If the remaining bone alone can hold the implant firmly, grafting and placement are done on the same day. At upper molars, if roughly 5mm or more of bone remains, the sinus floor is often raised through the implant hole and the implant placed at the same time. If less remains, a small side window is often opened to raise the sinus floor, and we wait for the bone to fill in before placing the implant. The threshold depends on your bone quality (how dense the bone is) and is decided with a CT.

Why we do thisDoing it on the same day reduces the number of surgeries and the overall time, but placing an implant with weak stability raises the risk that it will not bond to the bone. We look at the conditions for the implant to bond before the number of surgeries.

Enlarged panoramic X-ray 6 weeks after the sinus floor was raised through a side window and filled with graft material, showing a mass of graft material above the sinus floor — Graft surgery. The first photo is an X-ray 6 weeks after the sinus floor was raised through a side window and filled with graft material; a mass of graft material is visible above the sinus floor (same patient as Case 1). As in the next two illustrations, the graft material is covered with a membrane and the gum is stitched so that gum tissue does not grow into the space first.

Cross-section illustration with the gum folded back and the graft material covered with a barrier membrane — Graft surgery. The first photo is an X-ray 6 weeks after the sinus floor was raised through a side window and filled with graft material; a mass of graft material is visible above the sinus floor (same patient as Case 1). As in the next two illustrations, the graft material is covered with a membrane and the gum is stitched so that gum tissue does not grow into the space first.

STEP 04

We fill in graft material and cover it with a membrane

Under local anesthesia, we fill the deficient site with graft material. A barrier membrane is placed over the graft material to keep gum tissue out and protect the space where bone will grow. The site is disinfected the next day, and stitches are removed after 1–2 weeks.

Why we do thisGum tissue grows faster than bone. Without a membrane, gum fills the space where bone should form first, and less bone forms than intended.

CT cross-section right after bone was grafted first at the upper left second molar site — Time for bone to fill in. These are CTs of a site where bone was built first, right after grafting and 6 months later. On the 6-month CT, we confirmed that enough bone had filled in for an implant and placed it that same day. The two CTs were cut at slightly different angles, so the same heights cannot be compared directly.

CT cross-section of the same site 6 months later, with a virtual implant placed — Time for bone to fill in. These are CTs of a site where bone was built first, right after grafting and 6 months later. On the 6-month CT, we confirmed that enough bone had filled in for an implant and placed it that same day. The two CTs were cut at slightly different angles, so the same heights cannot be compared directly.

STEP 05

We wait for the bone to fill in and place the implant after checking with a CT

When bone is built first, we usually wait about 4–6 months, check with a CT and then place the implant. Even with same-day placement, we wait a few months longer than for a standard implant before placing the crown. The time depends on the bone condition.

Why we do thisHow fast graft material turns into real bone differs by person and by site. We do not place the implant just because the date has come; we check with a CT before moving on.

Periapical X-ray taken on the day the crown was placed on the upper right first molar implant. The dome-shaped graft area above the implant tip is visible — Crown and checkups. This X-ray was taken on the day the crown was placed on the implant of the Case 2 patient. The dome-shaped graft area above the implant tip remains in place, and at future checkups we compare with this photo to see whether the bone height is maintained.

STEP 06

The same doctor places the crown and does the checkups

Once we confirm the bone has bonded, we place the crown and check at 1 month, 3 months and 6 months after the crown, then every 6 months. At grafted sites, we compare the bone height on X-rays with the starting point.

Why we do thisGrafted bone can also shrink if inflammation develops. To keep the bone that was built for a long time, care after placement is as important as the surgery.

* Clinical photos were published with the patients' consent. Side effects such as temporary pain or discomfort may occur depending on the person.

04^°

What types of bone grafting are there?

01Guided bone regeneration (GBR)

When bone width or height is slightly short, graft material is added and covered with a membrane to build bone. This is often done at the same time as implant placement.

02Sinus lift (crestal approach)

When an upper molar site is slightly short of bone, the sinus floor is raised a little through the hole drilled for the implant and graft material is added. The implant is usually placed the same day.

03Sinus lift (lateral approach)

When an upper molar site is very short of bone, a small window is opened on the side of the gum, the sinus floor is raised a lot, and graft material is packed in. The implant is often placed after the bone fills in.

04Socket preservation

When a tooth is removed, graft material is placed in the socket to reduce bone shrinkage. We consider this when an implant cannot be placed right away.

05^°

Comparing methods

	Grafting and placement on the same day	Grafting first, then placement	Short implant
Good for	When the remaining bone alone can hold the implant	When too little bone remains to hold the implant	When height is slightly short but width is enough and you want to avoid grafting
Number of surgeries	Once	Twice (grafting, placement)	Once
Total duration	A few months longer than a standard implant	Usually placement 4–6 months after grafting, then a few more months to the final crown	Similar to a standard implant
Limits	Not possible if stability is weak	Takes the longest	Cannot be used at every site and is less suitable when the tooth on top is long · Used occasionally at sites where conditions fit
Health insurance	Even with an NHI implant (for people enrolled in Korea's National Health Insurance), additional surgery such as bone grafting is not covered
Cost	See the treatment cost guide →

06^°

For these people, another treatment comes first, or treatment is not needed

Good for you if

The CT shows your jawbone height or width is not enough
The bone below the sinus at an upper molar site is low
Another clinic told you implants are difficult because you have no bone

Other treatment comes first

You have gum inflammation: gum treatment comes first.
You have sinus inflammation (sinusitis): we first recommend ENT treatment.
You smoke: grafted bone does not bond well, so we first recommend quitting.

You may not need it now

The CT shows enough bone: we tell you that we graft only when the CT shows a shortfall, and do not graft if it is not needed.

07^°

Precautions after surgery (especially after a sinus lift)

Do not blow your nose hard. Pressure inside the sinus can rise and damage the membrane.
Sneeze with your mouth open.
Avoid using straws and smoking. They change the pressure in your mouth and slow healing.
For 1–2 weeks after surgery, do not chew hard on the treated side.
Flying and diving: avoid flying and diving for at least 2 weeks after surgery. If you have travel plans, let us know before surgery.
Take prescribed medicine as directed.

08^°

How we follow up after placement

Implants do not get cavities, but the gums and bone around them can become diseased like natural teeth. That is why we think how the implant is looked after in the years that follow matters more than the day it is placed.

1
Day after surgery
We disinfect the site and check bleeding and swelling.
2
1–2 weeks later
Stitches are removed.
3
1 month after the crown is placed
We check the bite height (occlusion) and how well it is being cleaned.
4
Then at 3 and 6 months
We check again 3 and 6 months after the crown.
5
Every 6 months after that
Regular checkups continue.
6
Every 3 months for higher-risk patients
If you have had gum disease (periodontitis), smoke, have diabetes or have several implants, we check every 3 months.

At checkups we: measure gum depth around the implant, check for gum bleeding and pus, compare bone height on X-rays if needed, do professional cleaning, adjust the bite height, and check the cleaning tools you use at home.

09^°

Self-check

It has been more than 1 year since your tooth was removedYou lost a tooth to gum diseaseAnother clinic told you that you do not have enough boneYou have lost an upper molarYour gums have become low after long-term denture useYou have sinusitis or a nasal condition

If any apply, we measure bone height and width on a CT and explain how many mm are missing.

10^°

Side effects and limits

Please read

· Swelling and bruising may last from a few days to about 1 week after surgery, usually worst on day 2–3.

· Some graft material may be absorbed, so less bone than expected may form and an additional graft may be needed.

· If the grafted site becomes infected, the graft material may need to be removed and the graft redone.

· During a sinus lift, the membrane may tear (perforation). If small, it is repaired during surgery and the procedure continues; if large, the surgery is stopped and redone after it heals.

· For a few days after a sinus lift, you may have a slight nosebleed or a stuffy nose.

· Smoking and uncontrolled diabetes make it harder for bone to bond.

· Bone grafting adds a few months to the overall treatment time.

FAQ

Do I have to get a bone graft for an implant?

We do bone grafting only when the CT shows that bone height or width is not enough. We show you on the CT screen why it is needed and how many mm are missing, and if it is not needed, we do not do it.

Visiting from abroad

Questions from patients who travel to Seoul for treatment.

How much does an implant cost?

OSSTEM or Dentium implants are KRW 1,200,000 per implant, and implants with a zirconia crown are KRW 1,500,000. If bone is lacking, a bone graft is KRW 200,000 to 1,000,000 per site, depending on your jawbone. International and Korean patients pay the same fees. See our fee schedule.

How many visits do I need, and how long should I stay in Korea?

Implants need time for the bone and the implant to bond firmly. So you either visit Korea more than once or plan a longer stay. The schedule depends on your bone and whether a bone graft is needed, and we explain it after a CT scan.

Can I have my consultation in English?

Yes. The doctor in charge of each field consults with you directly in English. For implants and gum care, this is Dr. Ilseop Ahn, a board-certified periodontist. Before you travel, you can send photos of your teeth on WhatsApp or by email. An accurate diagnosis is made after we examine you in person.

What happens after I go home?

Implants do not decay, but the gums around them can become inflamed. If you notice swelling, bleeding or movement, it needs to be checked. Send us a photo on WhatsApp if anything worries you. Regular check-ups and scaling help keep the area healthy.

Results, the number of visits and schedules vary from person to person. More questions: Visiting from abroad.

Implants and gumsImplants: do I really need one? And if so, who will see it through, how, and to the end?→Implants and gumsImplants under Korean health insurance: am I eligible, and how much will I pay?→Implants and gumsI have almost no teeth left, or they are all loose. Do I need full-mouth implants?→Implants and gumsMy gums bleed and my teeth are loose. Can gum treatment save them?→Implants and gumsMy gums have receded. Can they be restored?→

Treatment results and side effects may vary from person to person.

If you have a CT taken elsewhere, you can send it to us first

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