Would you use a short implant in this case?

What material is the bridge made of? what cement? Do the Class II boxes need to be perfectly vertical, or are they prepped with a bit of taper? I'm interested in doing this, thanks!

By the way, I think that in this case an inlay/onlay bridge is the ideal solution. I remain of the opinion that this is NOT an implant case, as I already stated in my original comment! The risks are too great.

Norris, Dok is referring to what is accurately called an inlay bridge, or onlay bridge, not a “modified Maryland bridge”. (Sorry Dok, there is no such thing as a “modified Maryland bridge”, at least not in American terminology.”) Have you never done an inlay or an onlay? If you haven’t here’s the shortest version I can give you, short of a lecture. When preparing for an inlay or onlay bridge, you prep the abutment teeth just like you would for an inlay or an onlay, i.e.: standard class II preparations with at least 5 degrees of taper, flaring outwards in all directions from the inside towards the occlusal and the proximal. The preps are done with flared flat-head diamond burrs. In an inlay bridge, you just prepare a class II preparation inlay (with that 5 degrees of taper). In an onlay bridge you prepare the same class II preparation AND cuspal protection, so that the tooth cusps are also covered, just like in a standard onlay. There is a certain way to prepare the cusps, with a reduction of 1-1.5 mm, while preserving their basic shape so that the restorative material practically “wraps around the cusp” while also rebuilding it — you don’t just cut down the cusp flat. An onlay bridge is better because it protects the cusps and therefore protects the tooth from developing internal cracks or, against fracture of a whole cusp or wall. In most situations one should always choose an onlay bridge when possible. Another advantage of the onlay bridge in this case, considering the patient’s age and horizontal bone loss, is that the bridge cusps can be modeled in such a way (and the occlusion can also be adjusted) to have less stress on the abutment teeth during lateral excursions, thereby protecting the periodontium to minimize future horizontal bone loss. The bridge can be made of any material, including metal, but the usual materials of choice are either lab-processed composites, porcelain, lithium disilicate, or zirconium. These bridges are usually bonded in, with the standard dentin/enamel bonding protocol and a composite cement. And yes, it can be made out of metal too but it will be very unsightly cosmetically. If metal, it’s cemented with either polycarboxilate cement if the teeth are vital, or zinc-oxyphosphate cement, if the teeth are non-vital. A metal bridge can also be bonded in (like composite or porcelain) but you’ll have to microetch the metal using a micro-etcher in order for the bonding material to stick to the metal. However, when bonding in a metal inlay bridge, consider also the possible need to remove it later — it will be much harder to remove. Once bonded in these inlay/onlay bridges CANNOT be removed by being tapped out with a sliding mallet, like ordinary bridges. Removal usually leads to destroying the inlay/onlay wings, regardless of the material used. There is also an entire protocol to insert them properly, as you MUST ensure that no composite cement gets trapped in the interproximal gingival embreasures and, you must finish and polish finely everywhere, including in the gingival embreasures. These bridges are not necessarily hard to do but they are finnickey, requiring attention to many details, much more so than standard crown & bridge. If you’ve never done this kind of bridge I suggest you first take a course on it. Otherwise, it will be much easier to do standard crown preparations and do a standard porcelain-fused-to-metal or zirconium bridge.

Also, on the bicuspid you must absolutely use an onlay or a crown (definitely not an inlay) because it already has endo. Yes, a combination bridge consisting of a crown on the bicuspid and an inlay or onlay on the molar can be fabricated in the lab using any of the modern composites or porcelains. It's done quite often.

There is only one premolar. The other premolar was extracted when orthodontic treatment was done decades ago. I would remove the tooth and place one implant. Short implant work fine. I used to think otherwise.

No not possible. The implant in this case would be placed superior to the mental foramen. You can't transfer / transposition the mental foramen.

There are so many comments here about rampant periodontal disease. Perio disease is not diagnosed my bone loss but an active attachment loss. This may be stable perio, but on a reduced periodontium. Only the dentist can answer us through an accurate perio assessment.