Begin main content

All-Ceramic Crowns Compared to Porcelain-Fused-to-Metal Crowns in Adults: A Review of Long-Term Clinical Effectiveness and Cost-Effectiveness

Last updated: September 23, 2013
Project Number: RC0487-000
Product Line: Rapid Response
Research Type: Devices and Systems
Report Type: Summary with Critical Appraisal
Result type: Report

Report in Brief

Context
A dental crown is a tooth-shaped cap that covers a damaged tooth to restore it functionally and improve its appearance. For more than 40 years, the gold standard for the repair of damaged teeth has been porcelain-fused-to-metal crowns. However, crowns crafted from other materials are also available.

Technology
Porcelain-fused-to-metal crowns consist of a noble or base metal fused to a porcelain overlay. Although they function well and have high fracture resistance, they are often criticized for being unappealing aesthetically. All-ceramic crowns are more aesthetically pleasing, but they are typically thought to be less resistant to chips and fractures than the porcelain-fused-to-metal ones. However, major advances in ceramic technology during the last 20 years have improved the longevity of all-ceramic crowns.

Issue
Despite the improvements made with respect to all-ceramic crowns, it is unclear whether they are now as durable as porcelain-fused-to-metal crowns. A review of the long-term (eight years or longer) clinical and cost-effectiveness of all-ceramic compared with porcelain-fused-to-metal dental crowns, as well as of the contextual considerations that may affect their clinical or cost-effectiveness, will help inform reimbursement decisions.

Methods
A limited literature search was conducted of key resources, and titles and abstracts of the retrieved publications were reviewed. Full-text publications were evaluated for final article selection according to predetermined selection criteria (population, intervention, comparator, outcomes, and study designs).

Results
The literature search identified 567 citations. After screening the abstracts, 3 studies were deemed potentially relevant, while 2 articles were added from a previous Canadian Agency for Drugs and Technologies in Health (CADTH) report on this topic. Of these, only 2 articles met the criteria for inclusion in this review — 1 non-randomized study and 1 cost-effectiveness study.

Key Messages

  • Compared with all-ceramic crowns, porcelain-fused-to-metal crowns:
    • likely have a higher 10 and 15-year survival rate
    • are likely more cost-effective after 10 years.
  • These conclusions are based on limited evidence.
  • There is a lack of evidence on the contextual considerations that may have an effect on the clinical and cost-effectiveness of specific types of dental crowns.

Question

  1. What is the long-term (eight years and longer) clinical effectiveness of all-ceramic dental crowns, compared to porcelain-to-metal dental crowns?
  2. What is the long-term (eight years and longer) cost effectiveness of all-ceramic crowns, compared to porcelain-to-metal dental crowns?
  3. What are some contextual considerations for all-ceramic crowns or porcelain-to-metal dental crowns that may affect their respective clinical or cost effectiveness?

Key Message

Limited evidence from one non-randomized study and one Australian cost-effectiveness study suggests that porcelain-to-metal crowns may have a higher 10 and 15 year survival rate and may be more cost-effective after 10 years than all-ceramic crowns. No comparative information regarding the contextual considerations that may have an influence on the clinical and cost-effectiveness of different crown materials was identified. The authors of the included non-randomized study analyzed factors that had an effect on the longevity of crowns, but they did not report separate analyses for different crown materials.