I started working with a 32 year old patient prior to any Spear courses in late 2023 who had severely shortened roots on #7 and 10 specifically but also some effect on 8 and 9. Patient has been in ortho since September 2023. Possible restorative options discussed with patient included:

Implants at 7 and 10 (ideal but unlikely due to insufficient space available per orthodontist)
Bridges from 6-8 and 9-11 only if centrals show no further signs of shortening and teeth are stable
If 8 and/or 9 shows any mobility or insufficient bone support, proceed with implant bridge with oral surgeon placing implants at 7 and 10 sites.

Seeing his PAN from ortho at the end of last year and with his age I'm planning on encouraging him to do option #3 with the implant bridge as a better long-term option. I'm trying to learn how to better restore anterior implants after never truly seeing the process for provisionals being used to shape the tissue correctly. Is this a bad idea for a first case to do this? Could I get guidance on what the precise steps would be for this? The oral surgeon will be placing the implants. The technique I learned as an associate from doctors at my first practice in Louisiana is:

Have a flipper made to replace the teeth that will be restored
Have teeth removed and implants placed; let the patient wear flipper until the implants are ready to restore
Remove healing caps, scan, then place bridge or individual crowns

Now in Colorado, I'm trying to improve on that. At which step would you typically make provisionals? Would that vary based on oral surgeon's opinion on immediately loading the implants? What expectations should I set for the patient during the transition? Patient is still going through further invisalign refinements with ortho. My current thoughts are:

Prior to extractions/implants, have diagnostic wax up completed for #7-10 and flipper to replace teeth.
Oral surgeon extractions/implants at 7 and 10; deliver flipper
8 weeks post implant placement, have patient come in for 60-80 minutes to have interim implant bridge fabricated on metal provisional abutments.
Let patient use provisional bridge for 8 weeks to stabilize tissue before scanning patient for permanent esthetic zirconia bridge.

Huge TIA for any help!

Attached are his pre-ortho photos and his current progress. PAN is from 12/27/24 as well.

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