Introduction: Patients presenting severe maxillary atrophy represent a challenge in terms of predictability, treatment time and complications. Prof. Branemark introduction of the zygoma fixtures to by-pass the alveolar area and reach the zygoma to obtain enough bone anchorage was a major breakthrough. Many patients were treated by either 2, 4 or 5 zygoma implants combined/or not with standard ones. The next frontier was to create enough initial stability for immediate loading.

Material and methods: One hundred and twenty patients, 79 females, 41 males between 18 and 70 years old with a diagnosis of severe maxillary atrophy were treated with zygoma implants and completed/or not with standard fixtures for primary stability and immediate loading. Patients were operated from November 1999 to November 2010, with a minimum follow up of 12 months. We used X-rays and computerized tomography, clinical and photographic evaluations and models in a semi-adjustable articulator. For complicated cases 3D models were used.

Results: 120 patients were esthetically and functionally rehabilitated immediately with temporary teeth. The prosthodontist continued the fabrication and final restoration to install them within 4–8 weeks after surgery.

No major complications were observed at 12 months follow up, other than treatable sinusitis.

This new approach eliminates the need for grafting, multiple interventions, or osseointegration period waiting.

Conclusions: This new protocols permit an ideal esthetic and functional treatment allowing immediate temporary prosthetic rehabilitation, decreasing costs, ensuring stability and fixtures long-term survival.