The past 30 years have seen a remarkable transformation and development of options for reconstruction of the maxilla. The fundamental tenet that all defects of the maxilla should be reconstructed with a prosthetic device has been transformed into a selective approach based on remarkable innovation in the use of myo-osseous or osteocutaneous free tissue transfer and the use of osseointegrated implants for comprehensive and functional dental restoration. The current approach integrates therapeutic decision-making, selecting the right reconstruction for the right patient based on maxillary defect extent and patient-specific goals and objectives.