When the concept of a single central implant in the edentulous mandible was first described over 25 years ago for denture retention as a cost-effective social solution in elderly patients, the idea was almost ignored in the dental community. Only in the last 10 years has this therapeutic concept been tested more extensively in various clinical trials. This article summarizes the current data, which proves that this therapeutic concept is very effective in the medium and long term, provided that the following principles are taken into account: (1) Use of implants with micro-rough surfaces; (2) Avoidance of immediate loading of the single implant via the retention element; (3) Using a ball as a retention element. Using selected patient cases, clinical results and complications are illustrated.