The removal of impacted and displaced teeth is one of the most common procedures in dentoalveolar surgery. Up to 80% of the population have at least one wisdom tooth impacted in the jaw. In the present case report, highly displaced tooth nucleus 28 was removed via a maxillary sinus window using a piezotome because of its close positional relationship to the roots of tooth 27 and to the maxillary sinus. Piezosurgery has been proven to reduce the risk to neighbouring soft tissue structures such as Schneider's membrane. To protect and preserve the mucosa of the maxillary sinus, a bone window was prepared and refixed with sutures after tooth removal. Consequently, the particular surgical technique should always be selected on a patient-specific basis.