We present a clinical case report of a 54-year-old female heavy smoker (30 packyears) with generalized periodontitis stage IV grade C who underwent implant surgery and prosthetic rehabilitation following the failure of her natural dentition in the maxilla. The surgical treatment involved the insertion of four implants with a bilateral external sinus procedure, and the decisions and steps taken to achieve the final treatment outcome were discussed in detail. This highlights the challenges in patient management, as the need for sufficient oral hygiene and cooperation is mandatory due to the increased failure rates in smokers. After a healing phase of several months, uncovering was performed, and the prosthetic treatment was carried out. A palate-free fixed prosthesis with a CAD/CAM bar was inserted. This case illustrates a challenging treatment plan, considering the patient's desire for a relatively cost-effective, fixed, and palate-free restoration of the maxilla.