Functional and aesthetic treatments are challenging when ensuring maintain long-term successful prosthetic rehabilitation after alveolar ridge resorption of the anterior maxilla. The goal of this case series was to evaluate implant success rate, prosthetic stability and patient satisfaction in patients treated by onlay bone grafting in atrophic premaxilla. Nineteen patients treated for severe atrophic anterior maxilla by reconstruction using onlay bone grafting and implant restoration between 2002 and 2012 were examined. The surgical procedure was designed to allow the insertion of 49 endosseous implants in the grafted anterior maxillae. Bone resorption and implant success rate were retrospectively evaluated after a follow-up period of 5 years (from 5 to 15 years) subsequent to reconstruction. A questionnaire was the medium used to evaluate patient satisfaction and highlight functional and aesthetic outcomes. The bone grafting success rate was 74%. None of the grafted bones were reported to be infected. Four implants were removed. Implant survival rate was 91.8% after 8.9 years. The permanent reconstruction was fixed in 74% of the cases and removable in 26%. The level of patient satisfaction reported was 6.5/7. In conclusion, his study suggests that onlay bone grafting can be considered a predictable technique for rehabilitation in atrophic premaxilla. The procedure has a high implant survival rate, acceptable bone resorption over time, and promotes graft stability for longterm prosthetic fixation, thereby increasing patient satisfaction.