The implant-prosthetic rehabilitation of severe maxillary atrophy often requires difficult bone grafting techniques or microvascularized flaps with long healing time and severe discomfort for the patients. An alternative is represented by the use of particular thick bone areas like "zygomatic buttresses" that are away from the alveolar ridge but they are good for anchoring implants. From 2008, 31 patients, aged between 52 and 82 years, with severe maxillary atrophy, have been rehabilitated using zygomatic implant (Zygoma Brånemark System®) and conventional implants (4 mm of diameter and a length of 13 to 15 mm); a total of 152 implants were inserted, 78 Zygoma implants and 74 conventional implants in the premaxilla. As dictated by our protocol, all of them were followed by immediate prosthetic loading. Follow-up ranges from 20 months to 5 years. Two Zygoma implants failed out of 78 fixtures inserted with a success rate of around 98%. No failure of conventional implants. Two patients developed a postoperative sinusitis; one case healed only after endoscopically guided medium meatal antrostomy. In one case the removal and reinsertion of one Zygoma implant was necessary. We observed two cases of temporary zygomatic hypoesthesia, two cases of persistent oedema for three weeks and one case of facial postoperative haematoma; all of them spontaneously solved after a few weeks. Our results are in agreement with the Literature and lead to the conclusion that the use of Zygoma implants is a reproducible and predictable alternative to bone grafts, with the advantage of a considerable saving of time.