Purpose: The management of 5 patients with extreme maxillary atrophy and treatment consisting of maxillary fixed prostheses supported by conventional implants and zygomatic fixations positioned according to the sinus slot technique is reported. Materials and Methods: A total of 16 conventional implants were placed, together with 2 pterygoid implants and 10 zygomatic fixations. In 2 cases zygomatic fixation could not be performed on the alveolar ridge, thus requiring palatal displacement. One patient presented nasogenian ecchymosis. The fixed rehabilitations were either screwed or cemented after 5 to 6 months. Results: Follow-up from implantation lasted 12 to 18 months, during which the prostheses and implants remained stable and in function. Discussion: The placement of zygomatic fixations based on the sinus slot technique offers advantages over the conventional technique, though extreme atrophy of the alveolar processes does not allow fixation at the supracrestal level, and complications may develop. Conclusion: While zygomatic fixation is a valid alternative for treating the atrophic jaw, long-term studies are required to confirm its efficacy. Keywords: atrophic maxilla, dental implants, sinus slot technique, zygomatic implants