The success of dental implants has long been considered to be dependent primarily on the quality and quantity of alveolar bone. Bone grafting allows patients with insufficient bone volume to obtain implant-supported prosthetic solutions for treatment of edentulism. While extensive bone grafting procedures have been commonly used to rehabilitate severely atrophic arches, they can be associated with long treatment times, unpredictability, and donor site morbidity. Nongrafting solutions have more recently been employed that maximally utilize the residual highly atrophic alveolar or extra-alveolar bone for implant therapy. With the use of modern diagnostic imaging and 3D printing technology, clinicians are able to provide individualized, subperiosteal implants that fully adapt to the patient's remaining alveolar bone. Other "graftless" implants, including zygomatic implants, utilize the patient's extraoral facial bone outside the alveolar process and have been shown to provide predictable results. This article discusses the rationale for graftless solutions in implant therapy and the data supporting the use of various graftless protocols as alternatives to grafting and conventional dental implant therapy.