4-Unit Implant Supported Bridge with natural tooth and implant: prognosis?

That would not be a valid/decent/acceptable option. Minimum two implants at 1st molar and 1st premolar and an implant supported bridge after integration. Plenty of bone to do that. 1st molar with internal sinus lift even without bone graft and 1st bicuspid exo+implant 2 surgeries (bicuspid has periapical pathology): wait 2,5/3 months after exo or check Peter Fairbairn's protocol. OR if real limited finances then RPD. No place for screwing around in implant dentistry.

this case in my office would most likely be an immidiate loading case but first i would take a cbct and possibly place 2 or 3 implants ..

The research does not support utilizing a fixed bridge supported by a natural tooth and a dental implant. Primarily due to the natural tooth retainer possessing a PDL, while the implant retainer does not possess a PDL. Two to three implants would be recommended in your case. If finances are the limiting factor, fabricate a RPD until the patient can restore the area properly.

well, I'll go against the current. I have been connecting teeth to implants since 1994. Bo Rangert, an engineer with the branemark group discussed attaching teeth to implants back in the early 90's. All of the above comments are valid as my first choice is always implant supported restorations independent of teeth. However, if absolutely needed and the patient understands this is less than ideal, and if the natural tooth is periodontally sound, no pockets, no mobility, then your four unit FPD idea is sound. Implant #5, then use a semiprecision attachment on the mesial of #2 (arrowhead type of attachment, placed with arrow pointing up so pontic will sit over it). I also use a little temporary cement on the attachment to stabilize the joint but make it removable if needed. Then make sure patient has a nightguard. Most practitioners that bad mouth implants to natural teeth have never done them. I want to know what "problems" these practitioners are talking about. The "problem" that hits the literature is intrusion of the natural tooth/teeth. That's why I don't recommend copings on natural teeth with a bridge temporarily cemented over the coping. Otherwise, there's absolutely no literature that says connecting implants to natural teeth causes a higher implant or tooth failure rate. I've had one implant failure when connected to natural teeth (your exact situation actually) in 22 years and it wasn't a result of the connected FPD.

I am a patient who had surgery 3 days ago to remove two natural teeth which supported a 4 tooth bridge and broke off at the gum line. The surgery also included starting a bone graft, and cleaning a pocket of infection next an existing adjacent tooth. This am a recurring temple pain has awakened me. It started next to the upper corner of my left (the surgery side) eye, and a little upward and further from my eye. The pain is not bad. It makes me wince, but only lasts a second or two. It occurs about every couple of minutes. Should I be concerned about a blood clot? The numbness is just beginning to wear off from the surgery.