Orbital floor fracture reconstruction is considered crucial in restoring the orbital volume and avoiding complications such as diplopia and enophthalmos. Traditionally, transcutaneous or transconjunctival approaches have been implemented to access the orbital floor fractures. However, these approaches suffered the drawbacks of possible visible scars, ectropion or entropion. Recently, the transantral approach has been revisited to access and reconstruct orbital floor fractures with adequate success. This is a retrospective study where transconjunctival and transantral approaches are compared in terms of complications and orbital volume correction after using customized titanium implants for orbital floor reconstruction. Ten patients were included in the transconjunctival group while eight were included in the transantral group. The mean volume of the reconstructed orbits in the transconjunctival group was 2.2% smaller than that of the contralateral intact orbits compared to 0.6% smaller volumes for the reconstructed orbits vs the intact orbits in the transantral group. It can be concluded that the transantral approach is a valid alternative to the transconjunctival approach for orbital floor reconstruction yet with fewer complications.