When the front of the upper jaw has lost most of its bone, the standard answer has long been four zygomatic implants, one pair on each side reaching into the cheekbones. Quad zygomatic treatment works, and it has decades behind it. It is also the longest surgical path in implant dentistry.
Transnasal dental implants offer a different route for some of these patients. Rather than heading up and out toward the cheekbone, a trans-nasal implant travels alongside the nasal cavity and anchors into the dense cortical bone of the lateral nasal wall. Same objective, a fixed set of upper teeth without bone grafting, on a shorter and more contained trajectory.
What Are Transnasal Dental Implants?
A transnasal implant is an extra-long dental implant, typically in the region of 16mm to 25mm, placed through the anterior maxilla so that its body runs along the lateral border of the nasal cavity. Contact with the cortical paranasal bone along that wall is what provides stability, rather than the resorbed alveolar ridge underneath.
The technique was first reported in Brazil in 2019, where it is known as the Vanderlim technique, described explicitly as an alternative to the quad zygomatic configuration. It has since been reported in case series and adopted by a small number of clinicians internationally. Several manufacturers now produce implants designed for this trajectory, with the nasal wall engagement built into the length and thread design.
A Note On Terminology
Searching for nasal implants online will mostly return two unrelated things: absorbable nasal valve implants used by ENT surgeons to help with breathing, and cosmetic implants used in rhinoplasty. Neither has anything to do with this.
Transnasal dental implants are titanium implants placed to support teeth. They are also referred to as trans-nasal dental implants, and one manufacturer markets its version as Nazalus. The related trans-sinus dental implants take a different path, through the maxillary sinus rather than beside the nasal cavity.
How Transnasal Implants Compare To The Alternatives
| Transnasal | Zygomatic | Pterygoid | |
| Anchors into | Cortical bone of the lateral nasal wall | Zygomatic bone, the cheekbone | Pterygoid plate, at the back of the jaw |
| Region restored | Front of the upper jaw | Front and sides, depending on configuration | Back of the upper jaw |
| Replaces | The anterior pair in a quad zygomatic plan | Extensive bone grafting | Sinus lift and posterior grafting |
| Evidence base | Emerging, since 2019 | Large, over three decades | Large, since the 1990s |
These are not competing products. A full arch plan for a severely atrophic maxilla often combines them, and published cases describe transnasal implants paired with zygomatic implants in the same arch under the all-on-4 concept, with conventional implants or short implants used wherever the bone allows.
Who Is A Candidate For Transnasal Implants?
Transnasal implants are worth assessing for patients who:
- Have severe bone loss in the anterior maxilla, where conventional implant placement is not possible
- Have been told they need four zygomatic implants and want to know whether the anterior pair can be avoided
- Have adequate subnasal bone and a workable lateral nasal wall on 3D imaging
- Are having a full arch treated and need anterior anchorage that the ridge cannot provide
- Want to avoid extensive bone grafting in the front of the upper jaw
The deciding factor is anatomy, and it is not visible on a standard X-ray. Cone beam computed tomography shows how much bone runs along the nasal wall, how much subnasal bone is present, and whether a trans-nasal implant would achieve enough lateral bone to implant contact to be stable. Published series report a mean of roughly 12 to 13mm of lateral contact with cortical paranasal bone where the technique is used, which is what makes it work.
How The Procedure Works
Planning comes first. Every case is mapped in three dimensions before surgery, because the margin for error alongside the nasal cavity is small and the angle has to be set before an incision is made. The same scan determines whether transnasal implants are the right answer or whether zygomatic, pterygoid or conventional implants would serve better.
Placement is carried out under sedation or general anesthesia. The implant is placed through the anterior maxilla and angled so the body engages the lateral nasal wall, with care taken to preserve the residual subnasal bone at the crest rather than fracturing it under excessive torque. Where sufficient primary stability is achieved, and published protocols describe insertion torque in the 40 to 50 Ncm range as the threshold, the arch can be restored with a fixed provisional prosthesis immediately. In appropriate cases that means our Teeth-In-A-Day™ protocol, with a full arch fixed the same day.
What The Evidence Shows
This is a newer technique than zygomatic or pterygoid implants, and the evidence base reflects that. It is a case series rather than large systematic reviews.
A published series of ten cases reported mean marginal bone loss of 0.70mm at twelve months after functional loading, which is within the range considered acceptable for conventional implants, alongside a mean subnasal bone availability of 5.46mm at the proposed implant sites. A separate 2024 case series described three full arch rehabilitations combining extra-long transnasal implants with zygomatic implants in immediate function, with no implant failures and all prostheses remaining in function through the follow-up period.
The honest summary is that early results are encouraging and long-term data does not yet exist. The authors of these studies say so themselves, calling for more research to validate the technique. Anyone presenting transnasal implants as a proven equal to zygomatic implants is getting ahead of the evidence.
Risks And Limitations
- Limited long-term data. The technique dates from 2019. Twelve-month and short-term outcomes look good; ten-year outcomes do not exist yet.
- Anatomically dependent. Not every patient has enough cortical bone along the nasal wall, and the scan decides rather than the preference of the surgeon.
- Technically demanding. The trajectory passes close to the nasal cavity and the implant may transverse the nasal fossa, which requires precise planning and control of insertion torque to avoid fracturing thin subnasal bone.
- Few clinicians place them. This is a small field. Experience varies widely and matters more than usual.
Where the evidence for zygomatic implants is stronger and the anatomy favours them, that remains the better-supported option. The point of assessing transnasal implants is that for some patients they avoid the anterior zygomatic pair entirely, and that is worth knowing about before committing to quad zygomatic treatment.
What Do Transnasal Implants Cost?
Cost depends on the case: how many implants the arch needs, whether one arch or both are being treated, the final prosthesis, and any preparatory treatment. A transnasal implant is priced in line with other advanced implant placement rather than as a separate premium, and a plan that avoids extensive anterior grafting is frequently competitive on total cost against the alternative.
We review the numbers in full at consultation and offer financing through CareCredit, Lending Club, Alphaeon, Cherry and Sunbit.
Frequently Asked Questions
What are transnasal implants used for? Supporting a fixed full arch prosthesis in an upper jaw with severe bone loss at the front, particularly as an alternative to the anterior implants in a quad zygomatic plan.
Do transnasal implants affect breathing? They are not placed into the airway. The implant runs alongside the nasal cavity engaging bone in the lateral wall, and normal breathing is not the target of the procedure or an expected consequence of it. Any implant placed near the nasal floor requires careful planning, which is why the 3D scan comes first.
Are transnasal implants safe? Published short-term outcomes are good, with bone loss at twelve months comparable to conventional implants. Long-term safety data does not exist yet because the technique is recent, and we say that plainly rather than implying otherwise.
Can transnasal implants be combined with other implants? Yes, and they usually are. Published cases combine them with zygomatic implants, and they sit naturally alongside pterygoid dental implants at the back of the arch and conventional implants wherever bone allows.
Are these the same as the LATERA nasal implant? No. LATERA is an absorbable implant used by ENT surgeons to support the nasal valve and help with breathing. It has no connection to tooth replacement. The similarity is only in the name.
Can I get teeth the same day? Often, yes, if the implants achieve enough stability at placement. That is assessed during surgery rather than promised beforehand.
Is this the newest type of dental implant? It is among the more recent techniques in wide clinical discussion, first reported in 2019. Newer does not automatically mean better, which is why we weigh it against the more established options for each patient rather than defaulting to it.
Schedule Your Consultation
If you have been told you need quad zygomatic implants, or that there is not enough bone in the front of your upper jaw for implants at all, it is worth having the scan looked at again before you commit.
Call our office at (347) 493-2439 or schedule your consultation online. We see patients in Manhattan, Nutley, NJ, Long Island and Bronxville.