Patients who are candidates for implant restoration of a completely edentulous maxilla may benefit from a fixed prosthesis rather than a removable tissue-supported overdenture prosthesis. Multiple surgical approaches are available to provide this type of care. Graftless strategies, such as those that utilize tilted implants, including zygomatic implants, allow the surgeon to establish adequate support for a fixed prosthesis without bone grafting by establishing sufficient anterior-posterior distribution of implants, thereby reducing or eliminating the use of distal cantilevers. For surgeons who may prefer to use a grafting approach for bone reconstruction in this group of patients, adjunctive procedures such as sinus grafting, maxillary osteotomies, and horizontal augmentations also are available. Being able to determine early in the consultation process the type of final prosthesis and surgical approach needed to provide the optimal functional and esthetic results is advantageous. Therefore, a systematic treatment planning protocol is essential for the evaluation of edentulous patients and those with terminal dentitions.