The ridge at #19 is atrophic (Fig.3), while the tooth #18 has mobility II (Fig.4).  It seems that the best option would be extraction of #18 and 20 and immediate implant with guide (Fig.4). 

FPD Last Next Guide

Xin Wei, DDS, PhD, MS 1st edition 12/03/2019, last revision 12/12/2019