UPDATE! 2/12/20 Bridge replacement. How to treat!
42 year old female with a bridge that has replaced missing lateral number 7 for many years. Multiple replacements have been successful but now patient would like a better esthetic result. One option would be to remove bridge and place implant in the lateral position and replace crown on 8 with a new esthetic crown. This will involve both hard and soft tissue augmentation with either GBR with simultaneous implant placement and CT graft or Graft and two stage implant placement possibly Khoury technique with multiple CT enhancements. But what of 8 in this case? It has been compromised and re-treated RCT at least once to my knowledge. It is a more than 20 year old original treatment RCT due to trauma. What if in 5 years it fails and needs and implant? We know two implants next to each other would be an aesthetic disaster. Should removal of number 8 with or without PET technique and cantilever #7 with tunnel CT graft at final placement be considered now? Honestly less complicated and possibly better long term outcome? Less complicated grafting with no hard tissue involvement? A nice tunnel with CT could be done first and then PET replacement. Possibly one more soft tissue augment at final placement. What do you all think?