Purpose: To present a new technique for the rehabilitation of the severely atrophied mandible that avoids the need for advanced surgical reconstruction. Materials and Methods: Severe resorption in the posterior mandible was treated following a conservative approach. A novel drilling technique and vertical implant-guided bone regeneration were performed to insert extra-short implants for maximum use of the bone above the mandibular canal. A progressive loading protocol was followed for the prosthetic rehabilitation with screw-retained prostheses. During the follow-up period, surgical complications, prosthetic failures, marginal bone loss, and implant survival were monitored. Results: The described conservative approach was effective in patients with residual bone height above the mandibular canal that was often less than 6 mm. No signs of sensory disturbances or nerve injury were detected during the observation period. One hundred fourteen extra-short implants were inserted in 72 patients, with a mean follow-up period of 26 months after implant insertion. The implant survival rate was 98.2% (two implants failed). Proximal bone loss was limited to 1 mm, and detailed analysis of factors influencing bone loss indicated that the increase in implant diameter was associated with a tendency toward decreased bone loss. Prosthetic complications (eg, fracture or screw loosening) were not observed in this study. Conclusions: This minimally invasive approach contributed to successful oral rehabilitation of patients with severely atrophied posterior mandibles. The development of conservative approaches will decrease the risk of surgical morbidity, save money and time, and decrease the complexity of surgery.