The severely resorbed maxilla poses difficulties for patient rehabilitation. This condition is characterized by the absence of bone for implant therapy and a reversed maxillomandibular relationship. Treatment for this condition is well established, but the correct time for reconstruction, implant therapy and Le Fort I osteotomy may vary. This paper describes a three-step procedure for the management of the severely resorbed maxilla. The three steps are: maxillary bone reconstruction; implant placement and building a fixed prosthesis in class III occlusion; followed by orthognathic surgery.