At the present time, treatment of the extremely atrophic mandible consists largerly of the insertion of endosseous implants, which provide retention and stability to fixed or removable dentures. In some cases the insertion of short implants, without surgical pretreatment, in the interforaminal area of the mandible is possible. If the bone volume is considered to be insufficient there are several techniques and materials to augment the extremely atrophic mandible, making the insertion of longer implants possible. Dilemmas in the surgical treatment of the extremely atropfic mandible are whether endosseous implants should be employed, whether the mandible needs te be augmented and which technique should be chosen. An insufficient number of copmarable clinical studies have been published to justify identifying any one method of treatment as the preferable on. The innovations in imaging techniques and the accompanying software will lead to advances in surgical treatment. The precise placement of implants will as a result become more exact, thereby possibly avoiding augmentation procedures and so diminishing complication and morbidity rates.