If a tooth has been broken or becomes severely damaged by decay, it may need to be surgically removed.  This procedure can be performed with a local anesthetic or an IV sedation.
A surgical tooth extraction involves teeth that cannot be seen easily in the mouth or a tooth that has broken off at the gum line.  A surgical extraction may also be performed as the result of a tooth that has broken off during the removal of a “simple” extraction.  To see or remove the tooth, a cut in the gum line may be necessary to expose the tooth.  By “flapping” the gum tissue back, it provides access to remove bone and/or pieces of the tooth. 
In some cases, the tooth may need to be sectioned into pieces for removal.