Dr sent these to me last week for eval. patient want #10 "fixed". my first thought was....extract #16 (since #1 is gone) and head to ortho. Doc said patient absolutely refuses ortho. sooooooo now what? how aggressive should i be? i mean, there's no way to prep that and stand it up. there's no proximal room even if you could. and there's very little occlusal room between 10 and 22.
let's spitball a few ideas...
If the patient wants to look like their teeth have always been normal, you have no option if ortho is refused. Aside from a year's pay of whole mouth plan.
Since they want fast, my initial thought would be a MD bridge. You'll have plenty of tooth to bond against with the space being so small that you can't fit it between 9/11 properly, it will be still looking different, but could possibly get it fairly similar to 7 with overrotation and incisal tilt.
A MDI type solution with a single tooth cemented on could be a candidate as well if they have the bone for it. The implant path would be different from the root path, allowing a very firm grasp by the threads. Yeah, it stinks, but I have a 5unit bridge out there on 4 of them and it's still going 7 years later. Only option that patient could afford.
If it were my case, I'd dupe the model 2-3-4 times and try various permutations. Deliver with a note outlining steps required for each variant and let the pt and doc choose. I'm also highly averse to clinical decision making. I'll offer options, and even suggest the one I like, but I always make them make the call, on paper.
