After 20 years of wearing a set of dentures, our recent patient decided to improve her quality of life and get permanent fixed teeth. Upon 3-D CT Scan, we found that patient had limited bone with her mandibular nerve on top of her mandible due to 20+ years of Atrophy of bone. Since her nerve rested on top of her mandible, an incision would risk numbness. We opted for a Flap-less and guided All on Four surgery using the Nobel Guide and Nobel Guided Surgery Kit. The Pictures show pre op X-ray, Nobel Guide planning, and the final post op X-ray. Enjoy. The case highlights the fact that persons with limited bone can still have successful and predictable implant placement.