Fixed implant reconstruction is one of the most challenging prosthetic treatment alternatives for the edentulous maxilla. Accurate diagnosis and treatment planning are essential to successful, predictable clinical results. Decisions concerning the placement of implants may have a lasting impact on the quality and prognosis of the final restoration. A series of clinical guidelines and considerations is presented with illustrative clinical treatment protocols of edentulous maxillae that vary in degrees of anatomical and prosthetic difficulty. This article addresses the fixed implant rehabilitation of edentulous maxillas with favorable anatomy and favorable arch position, favorable anatomy, and unfavorable arch position, and unfavorable anatomy and favorable arch position.