BACKGROUND This study describes a modified protocol using transmandibular zygomatic implants with immediate occlusal loading for the comprehensive dental rehabilitation of previously reconstructed mandibular defects and reports preliminary results of this modified protocol. METHODS Fifteen patients (6 female and 9 male), with a mean of age 40.26 years (range 12 to 68 years), had previously undergone immediate mandibular reconstruction using either autologous bone grafting, bone transport, or microvascular free-flap reconstruction for a variety of diagnoses. Transmandibular zygomatic implants were subsequently placed, depending on the type of defect. Implant stability was evaluated by insertion torque, percussion testing, and the implant stability quotient (ISQ). The patients were rehabilitated with an immediate provisional prosthesis. All patients' records included pre and postoperative clinical examination, radiographs, CT scan, and photographic analysis. All patients were followed for a minimum of 36 months. RESULTS All patients were dentally rehabilitated immediately with functional and esthetic hybrid dentures based on either acrylic or porcelain on a metal framework. Among all cases of transmandibular zygomatic implants, the ISQ was greater than 75, which allowed immediate prosthetic loading. The zygomatic implants were considered to be successful if they were asymptomatic with no clinical mobility and no sign of infection. We have also added new indications for placement of transmandibular implants in cases of sequelae of gunshot trauma, dentoalveolar defects, and complications of orthognathic surgery, partially edentulous and/or failure of prior mandibular reconstruction. CONCLUSIONS The zygomatic implant is an excellent immediate loading option for mandibular dental rehabilitation among patients with mandibular defects. According to our observation, immediate occlusal loading of transmandibular zygomatic implants has a very good potential for success.