Many studies have shown success with implants placed in grafted bone, and there is an emerging desire to simplify the treatment process by placing implants via a flapless approach using navigation or computer-aided design/computerassisted manufacture techniques. This paper reports a preliminary study of laboratory and clinical procedures that may enable flapless implant placement in patients treated previously with extensive onlay grafting of the severely resorbed maxilla, thereby avoiding secondary exposure of the grafted site. Six patients received 39 implants, with a cumulative survival rate of 97.7% over an average of 48.8 months; all prosthetic reconstructions are successful to date.