Implant Supported Bridge

[Gellia]

Hi,
I'm getting four implants to replace my four front top teeth (#7 - 10).  My regular dentist wants to give me a porcelain fused to low noble metal permanent bridge when they are ready.  When I expressed concern about a gray gumline (I already have gum recession) he just said he would shove that under the gums!  I asked about high noble and he said he doesn't do that!  
Can anyone advise me as to what they would suggest?  I'm terrified now that my front teeth will look flat and opaque, not to mention have a dirty gray line at the gum.
Any advise would be really appreciated.
Thank you so much.
Gellia
  

[scottma]

The best way to give you a final result of restoration is to have a diagnostic cast handy. Since  I do'nt have a diagnostic cast, I'll try my best to imagine your dental status  to establish  some treatment plans.
Four implants are ideal , but soft tissue (gingiva) may not be restored as natural looking gum. Black triangle may be present after tooth replacement. Papilla regeneration surgery may be needed to achieve optimal cosmetic results. Alternatively, if tooth #8 and 9 are pontics, it's much easier to fabricate a natural looking tooth.
Full ceramic crown is not a good restoration for implant, because the implant abutment is metal, which may compromise the shade of ceramic crown. Porcelain fused to metal generally yields acceptable cosmetic result although translucency is not as natural as full ceramic crown.
Removable partial denture generally yields satisfactor cosmetic result. If you are not comfatable with removable device, you can have precion or semipresion attactment on abutment of tooth# 6and11.It can be done with dolder bar and clip attachment or O ring attachment. Many devices are available for clinician's choice.
Finally, occlusion and phonation need to be addressed regarding anterior restoration.Keep in mind that implant does'nt always yield optimal cosmetic results. Final outcome can generally be previewed with diagnostic cast. These information are supposed to be presented by your resotrative dentist. Detailed consultation with your dentist is advisd.

[Gellia]

Thank you for your reply.
No, the implants have not gone in yet.  I will have a removable metal partial while they heal.
I'm wondering why I need a bridge at all!  Wouldn't four separate crowns be a wiser choice?  What would happen if I had a problem with an implant?  Wouldn't the whole bridge then have to be sacrificed?
I'd rather have separate crowns, if possible.  I don't think my regular dentist has ever done a 4-unit implant supported bridge.  He didn't say anything about separate ones either.  Just that he'd put on a "lower noble metal bridge" because they are cheapest.  I'm not interested in cheap, but the best cosmetic look I can obtain safely.  I also really didn't want more metal in my mouth as it hurts when the hygienist touches it with a dental pick.
What is your opinion of four separate crowns on the four implants?  Would it be strong enough?  Would all porcelain work, or would I need the metal base?
Thank you so much for your opinion.  This is driving me crazy and I crave information so I don't make a mistake.  
Gellia

[scottma]

It appears that implant has not been placed yet. The gray line is generally the neck of implant which is showing through thin gingiva. In order to achieve better cosmetic result, implants can be placed in the position of tooth #7 anf #10 which serve as abutment teeth for supporting pontics #8 and #9. However, neck of abutment crown may  or may not show grayish color, depending on the thickness of gum. If tooth #6 and 11, are solid, they can serve the abutment teeth for fixed bridge.Removable partial denture generally yields good cosmetic result, however, some patients refuse removable partial denture due to psychologic issue. Consultation with your dentist for detailed restoration options is advised.

[Gellia]

I've seen the final results of my husbands crowns on implants.  They are in the back of his mouth and I wouldn't want that in the front of mine.  The gray line shows already in his and they look flat and opaque dull.  
That is what my dentist is proposing for me.  As this is a VERY expensive bridge I was wondering if I should seek out a different dentist that does more front teeth bridges and at least uses high noble metals.
I have metal allergies and was never even asked about that.
I guess I would just like to know if it were you (or your wife), what would you like placed over four implants in the front of your mouth?  I am not concerned with the expense.  These are probably going to be for the rest of my life.
Thanks!

[scottma]

If implants have been placed and osseointegation has completed, the cosmetic result can be previewed with temp[oraries. Final restorations are generally the dupicates of temporaries.