Purpose: The purpose of this article is to describe the management of patients with extreme maxillary atrophy. Their treatment consisted of maxillary fixed prostheses supported by conventional implants placed in residual anatomic structures in conjunction with zygomatic implants positioned using the sinus slot technique of Stella and Warner. Materials and Methods: A retrospective chart review was conducted of all patients who received zygomatic implants between January 2000 and January 2005. The preoperative evaluations included panoramic digital radiographs and computed tomographic scan to identify the anatomic structures and detect the presence of pathology. All intra- and postoperative complications were recorded. Screw-fixed restorations were placed 4 to 6 months after implant placement. After prosthetic restoration, all patients received a minimum of 12 months' follow-up. Results: Twenty-one patients (11 women and 10 men) with severe maxillary atrophy underwent treatment with zygomatic implants placed using the sinus slot technique. Mean patient age was 54.1 years (range, 31 to 75 years). One patient presented with ectodermal dysplasia. A total of 89 conventional implants and 40 zygomatic implants were placed. During surgery, the sinus membrane was perforated in all cases; however, there were no significant postoperative complications. One patient presented with an ecchymosis. Two conventional implants failed; none of the 40 zygomatic implants failed. Mean follow-up after placement of the implants was 29 months, during which time the prostheses and implants remained stable and functional. Conclusion: Zygomatic implants, when positioned in conjunction with premaxillary implants, can facilitate the surgical rehabilitation of patients presenting with severe maxillary resorption, as an alternative to bone grafting. (Case Series) Keywords: atrophic maxilla, dental implants, sinus slot technique, zygomatic implants