Extreme atrophy of the mandibular alveolar crest can pose a great prosthodontic challenge, especially when the genial tubercles remain as a bony projection in the floor of the mouth. This article is a clinical report on the prosthodontic management of a severe mandible atrophy correlated with a prominent genial tubercle. A complete denture was carefully designed and fabricated in order to restore both the function and esthetics of the patient.