The maxillofacial patient faces many challenges that go beyond those of edentulism. These obstacles leave the patient handicapped and socially vulnerable. One of the greatest of these difficulties is retention of the craniofacial prosthesis. Ingenious strategies based on experience have provided limited success. For selected patients, however, the osseointegrated implant has largely eliminated this vexing technical predicament, thus freeing the patient to enjoy a more normal lifestyle. The treatment indications for this service, the remaining unresolved patient problems, the new planning criteria, and the requirement to document success all point to the need for well-validated instruments to measure the effectiveness of this newly augmented service.