Patient is a 59 year old female with multiple failing restorations. Tooth #18 is symptomatic and nonvital, it was necessary to remove the bridge to gain access to the tooth for endo treatment.

The patient was given two options for treatment:

1) extract #18, crown #20, and implant crown #18 and #19 OR

2) crown #18 and crown #20 and implant crown #19.

I felt like to restore the area with a bridge again would not be the best choice because of the inadequate amount of tooth structure on #18.

After completion of endo, she has decided that she wants to restore with a bridge and not do the implant on #19 or #18.

How much tooth structure do you need to endure long term success of a bridge?

I have been taught that 2mm to 1.5 mm of ferrule is necessary for a crown restoration to have adequate retention.

In this case, however the tooth has been endodonically treated and is tilted towards the mesial and will be an abutment on a bridge. With a crown lengthening procedure, I could have 2 mm of tooth structure for the bridge abutment.

For some reason I just don't think replacing the bridge with crowns on #20 and #18 and pontic on #19 is a good treatment option, even though I can get 2 mm of tooth structure for retention.

What would you advise, and how do I talk to my patient because I feel like I have tried everything I know to explain that I don't think this is the best decision for her, and it is a better decision to have implant placement on #19 and crown #20 and #18

or implant crowns on 18 and 19 and crown on #20.

How would you handle this situation?

There is a PowerPoint attached with x-rays and photos.