Have a cap #19, post got decay and rotted away, tooth has to be pulled. he wants to do a bone graph right away, insurance say's its not necessary and won't cover the 550 dollar cost. my question is how necessary is having a bone graph before having a implant.
I have reviewed your question and understand why you would need this extra information before continuing. An implant works best in healthy, dense bone. Oftentimes, when a tooth has been breaking down, the bone becomes unhealthy as well, sometimes there is infection also, which has caused greater loss of good bone. A bone graft is NOT always necessary. The best way to determine need for grafting is when the surgeon ( preferably a periodontist or oral surgeon)takes a CT scan of the area, and/or have that specialist extract the tooth and evaluate the bone at the same time. The CT scan is routinely done before implant placement to make sure that there is enough good quality bone, and that the jaw nerve is not too close, so an implant can be placed in the area.
I know that many general dentists are placing implants today, but be aware that oral surgeons and periodontists have years of training in the surgical placement of implants and bone grafts, not the short class a regular dentist would take.Therefore, my advice would be to discuss the reasons for the immediate graft, and if you are not satisfied with the answer, then go seek a the second opinion of an oral surgeon or periodontist.
Sometimes an implant cannot be placed in an area, and a 3 tooth bridge can be done instead. Most insurances will cover a bridge, and generally there should be no need for grafting.
Good luck with everything, I hope that I have answered your question fully.