The aim of this case report was to show the 10-year follow-up of a zygomatic implant supported rehabilitation treatment to replace the hybrid dental prosthesis with resin teeth - one by one - with ceramic teeth. The complications that occurred were described right from the time when the first implant supported prosthesis with immediate loading was placed, through the fabrication of a personalized dental prosthesis with twelve ceramic crowns, with a view to achieving esthetic excellence and restoring the patient's self-esteem. It was concluded that all patients with zygomatic implants must participate in a preventive maintenance program to assure the predictability of this type of treatment.

Introduction and importance The aim of this case report is to present a technical report for rehabilitation of patients with atrophic maxilla with the use of extra-long transnasal implants associated with unilateral zygomatic implants. Case presentation The indications, contraindications, planning and surgical procedure are described in order to give surgeons confidence in the management of this surgical approach to how to increase the range of rehabilitative options available to surgeons and patients. Clinical discussion Maxillary bone atrophy is a challenge demanding a high degree of experience of dental surgeons who trains themselves to rehabilitate these patients, whose treatment options range from bone grafts through to zygomatic implants. Extensive regions of atrophy require the use of 4 zygomatic implants which, in spite of offering predictability of the treatment, increase the surgical risk, require zygomatic bone with volume for anchoring 2 zygomatic implants. Generally, this bone density is reduced in elderly patients, making apical anchorage of the implants unfeasible. Conclusion The case report presented is a feasible alternative for replacing the placement of a second zygomatic implant, thereby diminishing the surgical risk, and making it possible for the technique to be more extensively used and performed by a larger number of surgeons.