A Piece of Bone Came Out with My Extracted Tooth: Should I be Concerned?

Bone came out with my extracted tooth: should I be concerned
Noticing a portion of bone coming out with an extracted tooth can be alarming, but rest assured, it's rarely the case. Typically, it's a minor issue that resolves naturally during the healing process.

However, extensive damage involving a substantial portion of the jawbone is a more serious situation, demanding specialized care.

In this article, we'll focus on bone damage associated with tooth extraction, when a fragment of bone breaks off or comes out along with the tooth.

What Exactly Does It Mean When a Piece of Bone Comes Off During Tooth Extraction?

One of the most common intraoperative complications of tooth extraction is damage to the bone supporting the tooth. This often involves a piece of bone breaking free or coming out with tooth.

To better understand this issue, it's essential to grasp the two main parts of the jawbone.

the difference between the basal bone and alveolar bone

Alveolar Bone or Tooth Socket

The first part is the alveolar bone or the tooth socket, where teeth are firmly lodged. Ligaments attach the roots to the socket, keeping teeth securely in place.

Basal Bone

The remaining portion of the jaw, which doesn't support the teeth, is known as the basal bone.
Fortunately, in most cases, the damage is limited to the tooth socket, making it a minor problem that dentists can manage effectively to ensure smooth healing.

However, in rare situations, complications may extend beyond the tooth socket and involve the basal bone, especially in wisdom teeth extractions. Wisdom teeth sometimes have abnormal shapes and positions, making the extraction procedure more challenging.

When the fracture extends to the basal bone, affecting a substantial part of the jaw, it becomes a more serious issue. In such cases, proper management is crucial to prevent further complications and ensure a successful recovery.

What does it look like?

It presents as a piece of broken bone, or a fragment attached to the roots when the tooth is removed.

A fragment of bone came out attached to the tooth roots after tooth extraction

Is Bone Damage Common During Tooth Extraction, and Should I be Concerned?

During the extraction, the dentist gently moves the tooth to break the ligaments holding the roots to the bone, making the tooth looser and safe for removal.

Although the risk of bone coming out with the tooth is generally low, it is one of the most common intraoperative complications.

Typically, a small piece of the alveolar bone may break off or come out with the roots. This is because the alveolar bone is thinner and less resistant than the robust basal bone.

In most cases, this poses no issue and doesn't impact the healing process. The wound and any small defects will heal normally, with new bone filling the empty socket.

Less commonly, a significant portion of the alveolar bone, supporting multiple teeth, may break. This can leave the teeth in the fracture zone loose and unstable. Typically, dentists can often reposition and stabilize the bone, promoting healing and consolidation with the underlying bone. Yet, if the bone fragment is freely broken, highly mobile, or too small, it may need to be removed to prevent potential infection.

The rarest and most severe situation involves the basal bone. Extensive damage to the upper or lower jaw can have potential long-term consequences. If left untreated, they can impact tooth alignment, hinder chewing, affect facial appearance, and lead to infectious complications, tooth loss, and joint issues.

mandibular fracture

Fortunately, the likelihood of these severe complications is very low. For instance, the reported frequency of lower jaw fractures after wisdom tooth extraction ranges between 0.0033% and 0.0049%. This complication may manifest on the same day or up to four weeks after the operation.

Fractures of the upper jaw can also occur, especially in the area behind the wisdom teeth (maxillary tuberosity). The upper jaw's proximity to the sinuses means a fracture in this area can lead to communication between the mouth and the sinus, potentially causing infection or sinusitis.

What may Cause the Bone to Come Out During the Extraction Procedure?

While bone damage during extraction is not uncommon and can happen to anyone, various factors contribute to the risk, including:

Excessive forces used to remove the tooth:

The dentist applies rotary and back-and-forth movements to the tooth. When these forces exceed the bone's strength and resistance, a fracture may result. The risk is even higher if the bone is already weakened, such as in cases of infection or cysts.

The procedure was challenging:

The likelihood of bone breakage is higher in complex extraction procedures compared to simpler ones. Complex dental extractions involve drilling into the bone, reducing its height to better expose the tooth. Although this technique makes tooth extraction easier, it can also weaken the bone.

The tooth is deeply impacted or ankylosed:

Teeth deeply embedded within the jawbone (deep inclusion) or fused directly to the bone without ligaments holding them (dental ankylosis) are two conditions that increase the risk of bone complications during extraction.

Deep Inclusion: Extracting deeply included teeth may require the removal of a substantial portion of the bone. Occasionally, a small bone fragment may break during this process, but this does not usually cause any serious problems.

Dental Ankylosis: Ankylosed teeth, firmly attached to the bone, are more difficult to extract than non-ankylosed teeth. As with impacted teeth, they often require surgical extraction by trimming the surrounding bone.

Age and medical conditions

Bone density decreases with age, including in the jaws. As a result, the jawbones become less resistant and can break under excessive force.

Additionally, medical conditions such as osteoporosis can weaken the bones, making them more susceptible to damage during tooth extraction.

How Can the Dentist Manage the Situation?

When a piece of bone has loosened or detached during tooth extraction, the first step is to remove the fractured fragment, as leaving it in place could hinder the healing process and potentially lead to an infection, known as alveolitis or socket infection.

Subsequently, the dentist will clean the socket thoroughly and smooth its edges to prevent the formation of spurs or sharp bony prominences, which might cause discomfort later.

The final step involves stitching the gum back together to facilitate proper wound healing.

Treatment of intraoperative bone damage following wisdom tooth extraction

In cases where a significant portion of the bone around the tooth breaks during extraction, the dentist may try to reposition the fractured segment and stabilize it in this position to allow for consolidation. Extraction is then scheduled once the bone has fully healed.

However, if the fracture extends to the basal bone, it is typically a serious injury that may necessitate specialized intervention from professionals such as maxillo-facial surgeons and ENT specialists.

Regardless of the treatment approach, it is vital to diligently follow the post-operative recommendations provided by your dentist or surgeon. This often involves adhering to prescribed medications, maintaining proper oral hygiene, and following a specific diet to ensure a smooth and successful recovery.

What are the possible complications?

If bone damage during extraction is properly managed, the following complications are less likely to occur. However, it's essential to keep them in mind so you can act promptly if they arise.

Loss of Jawbone Structure

If a significant portion of the bone is broken without successful consolidation, it can result in the loss of jawbone structure. Bone loss can affect your facial features and may present challenges later, especially if you plan to replace the missing tooth with an implant.

Uneven Bone Contour

Irregular alveolar bone ridge after tooth extraction healing

Damage to the bone during or after the procedure may cause it to lose its natural shape, resulting in an irregular form as it heals.

Bone Spur

Bone spur after tooth extraction

Bone damage during the procedure can leave fragments in the socket. As the healing progresses, the body will expel the unwanted dead bone toward the gum, forming a protrusion known as a bone spur.


Leaving a bone fragment inside the socket can lead to infection. The dead tissue can become a breeding ground for bacteria, leading to symptoms like redness, swelling, pain, and pus discharge. Extensive damage can also affect nearby structures; for instance, bone damage in the upper back teeth can impact the overlying sinuses, potentially causing sinusitis.