Routine extractions are performed on teeth that are visible in the mouth, usually under local anesthetic, and require only the use of instruments to elevate and/or grasp the visible portion of the tooth. Typically, the tooth is lifted using an elevator, and using dental forceps, rocked back and forth until the periodontal ligament has been sufficiently broken and the supporting alveolar bone has been adequately widened to make the tooth loose enough to remove. When teeth are removed with forceps, slow, steady pressure is applied with controlled force, and when the tooth comes out, it does so gently.
Surgical extractions involve the removal of teeth that cannot be easily accessed, either because they have broken under the gum line or because they have not erupted fully. Surgical extractions almost always require an incision and removal of soft tissue or bone. In a surgical extraction, the doctor may need to section the tooth into multiple pieces to facilitate its removal.