Treatment of the severely resorbed maxilla traditionally has been managed with such protocols as sinus elevation, bone and soft-tissue grafting, and osteotomy procedures. The use of zygomatic implants has made it possible to circumvent such procedures, allowing immediate loading of implants with fixed prostheses.This study reports the success rate of 452 zygomatic implants placed and restored in 249 patients over 5 years in a multi-center setting. Additionally, case examples are presented.The authors conducted a multi-center case series study. Inclusion criteria were ASA 1 or ASA 2, nonsmoking adults over age 30, fully or partially edentulous, with severely atrophic maxillae. These patients had zygomatic implants placed over a 5-year period with a follow-up of 5 years. The survival rate of these implants is described.A total of 249 patients, aged 34 to 80, had 452 zygomatic implants placed. Survival rate was 95% for quad zygoma; 99.1% for unilateral zygoma with additional premaxillary implants; 98.7% for bilateral single zygoma with additional premaxillary implants; and 100% for unilateral zygoma as a distal extension in implant-supported fixed prostheses. Overall implant survival rate was 97.6%.This study supports reports of zygomatic implants having a high success rate while allowing an array of ancillary procedures to be avoided.The use of zygomatic implants in the atrophic maxilla has shown to be a reliable treatment option for patients selecting to not undergo advanced bone-replacing protocols.