The use of “anteriorly or posteriorly” tilted implants in a graftless approach for immediate loading the edentulous maxillae has been well documented in the literature. This treatment concept allows for rehabilitation of the edentulous maxillae with a fixed prosthesis. The purpose of this article is to describe criteria for the use of the zygomatic implant, including the expanded use of the zygoma implant in cases where failure of one of the anterior or posterior tilted implants has occurred in the All-on-Four treatment concept. Zygomatic implant placement becomes a “rescue procedure”, which allows for continuity of care without resorting to a removable denture.