Dr. Caesar Butura - "Nasal Implants"
Episode summary
In this ZAGA Centers Podcast episode, Phoenix oral and maxillofacial surgeon and ZAGA Center member Dr. Caesar Butura previews his Edentulism 2025 lecture on nasal implants for the atrophic anterior maxilla. Drawing on Le Fort I surgical experience, he places implants in the dense lateral nasal wall, piriform rim, and vomer to stabilize a full-arch maxillary prosthesis. Butura positions nasal implants as a complement to zygomatic and pterygoid implants that offsets the anterior cantilever, which is especially problematic in quad-zygoma cases lacking adequate anterior-posterior spread. He describes it as a rediscovered rather than new technique, traced to early work by Cesar Guerrero and images in Branemark's literature. He emphasizes CBCT-based treatment planning with plan A/B/C anatomical options, identifies cleft patients and severely atrophic cases as the toughest, and names lack of osseointegration as the primary complication, occurring in roughly one in ten cases.
Key takeaways
- Nasal implants anchor a full-arch prosthesis by placing implants in the lateral nasal wall, piriform rim, or vomer of the anterior maxilla.
- The technique is used in conjunction with zygomatic, pterygoid, or conventional posterior implants to stabilize the arch and reduce anterior cantilever.
- The lateral nasal wall is dense bone familiar to oral surgeons because it serves as the buttress for rigid maxillary fixation after a Le Fort I osteotomy.
- The most common pairing in Butura's practice is two lateral nasal or two piriform implants combined with two zygomatic implants.
- Butura considers nasal implants a rediscovered technique rather than a new one, citing early work by Cesar Guerrero (Venezuela) and images in Branemark's literature.
- The primary complication is lack of osseointegration due to micromobility, which Butura estimates occurs in about one in ten cases.
- Cleft patients and patients with only one to two millimeters of subantral bone are the most challenging or contraindicated cases; where the lateral nasal wall fails, short palatal implants (e.g. 4x5 or 4x6 mm) can be placed to offset the anterior cantilever.
What you'll learn
- How to anchor implants in the lateral nasal wall, piriform rim, and vomer of the anterior maxilla
- Using nasal implants to eliminate the anterior cantilever created by quad zygoma or two-zygoma cases
- Reading the CBCT for available anterior anatomy that is often overlooked
- A plan A / B / C treatment-planning decision tree across the three anatomical targets
- Recognizing case contraindications (cleft patients, 1-2 mm of subantral bone) and managing lack of integration
About the guest
Dr. Caesar Butura
Dr. Caesar Butura is a board-certified oral and maxillofacial surgeon in Phoenix, Arizona, and founder of Butura Oral and Dental Implant Surgery. He is a member of the ZAGA network, with his Phoenix clinic operating as a certified ZAGA Center. He has worked in full-arch rehabilitation for roughly 17 to 18 years and began developing anterior-maxilla implant techniques around 2008-2009, collaborating at that time with Ole Jensen.
Credentials: Oral and maxillofacial surgeon; founder, Butura Oral and Dental Implant Surgery, Phoenix, Arizona; ZAGA Center Phoenix member
ZAGA profile · LinkedIn · oralsurgeryphoenix.com
