Purpose: This study was designed to evaluate long-term performance of zygomatic implants using an alternative apical fixation point to establish the posterior restorative foundation for fixed full-arch restoration. Materials and Methods: A retrospective study of all consecutively treated patients with advanced maxillary resorption who were treated with zygomatic implants to support fixed prostheses from August 14, 2001 through November 24, 2009 was conducted; the final follow-up was August 31, 2015. All zygomatic implants were placed using the malar prominence of the maxillary bone for apical fixation. Initial study casts were analyzed to compute the anterior/posterior implant distribution, distance between bilateral zygomatic implants, and variation from ideal zygomatic implant positioning relative to the soft tissue crest. Soft tissue, implant, and restorative complications also were recorded. Results: Fifty-eight consecutively treated patients with advanced maxillary resorption were included in the study- 18 men and 40 women, with a mean ± SD age of 65.3 ± 8.0 years and range of 49 to 85 years. Forty-nine patients received bilateral zygomatic implants placed apically into the malar process of the maxillary bone, and nine patients received similarly placed unilateral zygomatic implants with 107 zygomatic implants reported. All patients had supplemental anterior implants and were restored with a one-piece splint framework and fully implant-supported restoration. Follow-up of 5 to 13 years was conducted, with a mean follow-up time of 8.4 years per zygomatic implant. No losses of zygomatic implants occurred. No major surgical or restorative complications were observed. Conclusion: Utilizing the malar prominence of the maxilla for apical fixation of zygomatic implants predictably allows prosthetic placement of the implant platform in a favorable first molar position, eliminating prosthetic compromise. Keywords: implant, malar, maxilla, sinus, zygoma, zygomatic