An antrolith, a calcified mass within the maxillary sinus, is sometimes misdiagnosed as a tooth, a foreign body, or a septa in the maxillary sinus. Small antroliths are usually asymptomatic, while large antroliths may result in sinusitis with pain and discharge. A 28-year-old female patient without any clinical symptoms visited our department for the evaluation and removal of a tooth-like mass located in the left maxillary sinus before an implantation treatment. Radiographic evaluation showed a

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... calcified mass of size 0.7x0.4 cm located in the posterior region of the left maxillary sinus. We compared the size of the calcified mass to a tooth for differential diagnosis. During the surgery, we used a piezoelectric device to minimize the damage to the bone. The mass was successfully removed, and the excised specimen was diagnosed as an antrolith. After repairing the perforated membrane, sinus graft was performed. Six months after the operation, an implant was successfully placed in the left second molar area. For implantation treatment, it is necessary to examine the radiopaque lesion thoroughly by using cone beam computed tomography (CBCT). In conclusion, a surgeon needs to understand the anatomic variations and lesions of the maxillary sinus pre-operatively to make the approrpiate choice of surgical instruments.