A patient has a 3-unit fixed bridge supported by teeth #8 and #10 as abutments. Tooth #9 is the pontic. Radiographically, tooth #10 shows 9mm of vertical bone loss. What is the most appropriate treatment?

Correct answer: C. Extract tooth #10 and redesign the bridge or plan an implant

• A. Adding more abutments to a tooth with 9mm bone loss distributes forces but does not address the underlying severe periodontitis destroying the supporting bone.
• B. Root canal treatment does not address periodontal bone loss. Unless there is also a pulpal problem, RCT would not change the prognosis of tooth #10.
• C. CORRECT. 9mm of vertical (angular) bone loss indicates severe periodontitis with an extremely poor prognosis for tooth #10. Keeping a tooth with such advanced bone loss as a bridge abutment risks further progression, compromises the entire fixed bridge, and can lead to sudden failure. EXTRACTION of #10 and redesign of the prosthetic plan (extended bridge, implant) is the appropriate definitive treatment.
• D. Monitoring without definitive treatment is inappropriate for a tooth with severe bone loss that is compromising a prosthetic restoration.