Background: Limited bone quality in the posterior maxilla results in low success rates for dental implants. Various bone augmentation methods have been described, yet most require two‑step surgical procedures with relatively high rates of resorption and failure. An alternative for these patients is zygomatic implants. Zygomatic implants utilize the basal craniofacial bone. Materials and Methods: A retrospective study was conducted on 25 patients exhibiting ridges classified as V–VI according to the Cawood and Howell classification. Seventy‑six extramaxillary zygomatic implants were placed. Immediate rehabilitation was performed with a mean follow‑up of 18.6 months. Results: Three implants failed, and two were replaced successfully. No significant bone loss was observed in the rest of the implants. Soft tissue around the implant heads healed properly. All implants were prosthetically rehabilitated successfully. Conclusions: Zygomatic implants allow for immediate loading of an atrophic maxilla. The emergence of the implant is prosthetically correct compared to the intrasinus approach, leading to better dental hygiene and decreased mechanical resistance. 96.1% of the implants survived, with good anchorage and proper soft tissue healing and rehabilitation. We suggest using extramaxillary zygomatic fixture as the first line of treatment in severe atrophic maxilla.