Many dental practitioners do not differentiate between the complex extraction and the surgical (trans-alveolar) extraction. By definition, the surgical extraction is one of complex extraction procedures, but the complex extraction is not limited to surgical extraction. In this chapter, the complex extraction has been defined. The pre-operative, intra-operative and post-operative factors that may contribute to the complexity of dental extraction have been discussed. This chapter contains a separated part about the management of medically compromised patients, as those patients can be considered under the definition of complex extraction. This chapter also contains a separated part about physics of elevator’s uses.