Forty-three patients with severely resorbed maxillae who had been referred for implant treatment were assigned to 1 of 3 treatment options: bone grafting and implant placement (graft group), modified implant placement with no bone grafting (trial group), or optimized complete dentures (no-implant group). Sixteen, 20, and 7 patients, respectively, were assigned to the 3 groups. The patients have been examined annually, and at the time of this report they had been followed for 3 to 5 years after treatment. At the 1-year follow-up, 10% (22 of 221) of the implants had been lost, and at the 2-year follow-up, 18% of the implants had been lost (40 of 221; 25% in the graft and 13% in the trial group); after that time, no further losses occurred. Life table analysis showed cumulative success rates of 82% in the graft group and 96% in the trial group after 1 year, and 74% and 87%, respectively, at the final examination after 3 to 5 years. The failure rate was higher in smokers than in non-smokers. A substantial reduction of the grafted bone, especially of onlay grafts, occurred early after grafting surgery in many patients. Mean marginal peri-implant bone loss was 0.6 mm during the period from prosthesis connection to the 1-year follow-up, and from the 1-year to the 3-year follow-up, average peri-implant bone loss was 0.3 mm in the graft group and 0.5 mm in the trial group. The results corroborated previous findings that patients with severely resorbed maxillae have an increased risk of implant failure in comparison to patients with good bone quantity and quality. However, in this investigation, practically all implant losses occurred during the first 2 years, whereupon a steady state seemed to follow for up to 5 years after loading. Schlagwörter: bone graft, bone resorption, dental implants, oral radiography, osseointegration, sinus inlay