Zirconia or porcelain crowns: which should you choose?

What does “porcelain crown” actually mean?

English patient information uses “porcelain” for more than one kind of crown. Leeds Teaching Hospitals NHS Trust lists tooth-coloured porcelain with a metal lining for strength, and tooth-coloured all-ceramic or porcelain crowns. Cleveland Clinic groups “all-ceramic or porcelain” crowns together and describes porcelain-fused-to-metal (PFM) crowns separately. The NHS says crowns are usually made from metal, ceramic or porcelain fused to metal.

So a quote for a “porcelain crown” may mean a crown with a metal framework underneath, or one with no metal at all. These are the main types you are likely to be offered:

The question “zirconia or porcelain?” is therefore often really “metal framework or no metal?”. Before treatment, ask which type is planned for each tooth.

How do zirconia and metal-ceramic crowns differ in appearance?

Cleveland Clinic says PFM crowns combine the durability of metal with the natural look of porcelain, but the porcelain can chip over time and expose the metal underneath. It describes all-ceramic crowns as mimicking tooth enamel more closely than any other type of crown.

Zirconia has no metal core, so it cannot cause the dark line at the gum edge sometimes seen with older metal-ceramic crowns, as our zirconia crowns page explains. That page also notes that zirconia can be layered with porcelain for a more natural translucency, especially on front teeth.

No crown can stop the gum from receding. The University Dental Hospital of Manchester lists, among the risks of crowns, that people with thin gums may have slight recession that exposes a darker root surface or the edge of the restoration. In a 2018 review of crowns on implants by Pjetursson and colleagues, zirconia crowns had fewer aesthetic complications than metal-ceramic ones.

What does research say about how long each type lasts?

The answer depends on which zirconia was studied, on which teeth and for how long:

• Crowns on natural teeth: a 2015 systematic review by Sailer and colleagues in Dental Materials estimated five-year survival at 94.7% for metal-ceramic crowns and 92.1% for zirconia crowns with a porcelain layer. The zirconia crowns were lost more often through fractures of that porcelain layer and came loose more often. Glass-ceramic crowns reinforced with leucite or lithium disilicate reached 96.6%. The authors concluded that zirconia-based crowns should not be a first choice because of their technical problems.
• Crowns on implants: in the 2018 review by Pjetursson and colleagues, five-year survival was 98.3% for metal-ceramic and 97.6% for porcelain-layered zirconia crowns. Chipping was similar in both groups, but more zirconia crowns failed through fracture of the material. The authors called zirconia crowns a valid alternative to metal-ceramic crowns on implants. No studies of monolithic zirconia met their criteria.
• Monolithic zirconia: a 2022 review by Leitão and colleagues in the Journal of Prosthodontic Research found survival of 91–100% in studies with follow-up of only 0.3 to 2.1 years.

These figures are averages from studies, not a forecast for your mouth, and long-term data on monolithic zirconia are still limited. How to protect a crown day to day is covered in how to care for zirconia crowns.

Which type suits front teeth, and which suits back teeth?

For front teeth, appearance usually matters most. Leeds Teaching Hospitals lists all-ceramic or porcelain crowns for teeth where the crown can be seen and the bite is not heavy.

For back teeth, the chewing load matters more:

• In the Sailer review, porcelain-layered zirconia crowns and weaker silica-based ceramics survived significantly less well on back teeth; the other types did similarly at the front and the back.
• Leitão and colleagues concluded that monolithic zirconia may be an option for single crowns, especially on back teeth.
• Cleveland Clinic says zirconia withstands heavier forces than other ceramic crowns and is gentle on the opposing teeth, while PFM crowns may gradually wear the enamel of the teeth they bite against.

Grinding and clenching count too: in the Leitão review, results were markedly worse in the one study that included people who grind their teeth. If you have a metal allergy, Cleveland Clinic calls all-ceramic crowns a good choice. Because the tooth position, bite and gums all play a part, the material for each tooth is decided at the examination.

Should you replace old metal-ceramic crowns while you are here?

Many people travelling for treatment wonder whether to replace all their old crowns at once. Cleveland Clinic advises replacing a crown when you notice wear, tear or damage, and calling your dentist about a loose crown, cracks or chips, or a bad taste. If your main concern is a dark edge at the gum, the cause matters: it may be the metal margin of the crown, or a darker root showing where the gum has receded, as described above.

Before deciding, weigh this:

• Each new crown carries some risk. Cork University Dental School and Hospital notes that in 10–20% of cases the nerve of a tooth dies after a crown is placed, which may mean root canal treatment later.
• The tooth under an old crown needs checking. The Cork leaflet warns that decay can develop around a crown and, if it goes unnoticed, the tooth may need root canal treatment and a new crown, or extraction. X-rays and an examination show this better than photos.
• Hidden problems can lengthen your stay. If a tooth under an old crown needs root canal treatment, see do you need a crown after root canal treatment?.

Send us clear photos and any recent X-rays on WhatsApp before you travel for a preliminary assessment. Which crowns are worth replacing is decided after the examination and X-rays.

What will your dentist at home need to know?

The General Dental Council advises speaking to your own dentist before travelling for treatment, as they need to know your plans in case of later complications.

The material matters later, too. A 2022 literature review by Alqarawi and colleagues in F1000Research describes repairing chipped ceramic in the mouth as simpler than replacing the whole crown, but states that the framework material determines the repair procedure. The authors add that success depends on the clinician’s technique and on following the right protocol. A dentist who knows whether a crown is metal-ceramic, layered zirconia, monolithic zirconia or glass ceramic can plan a repair, or a replacement, more easily.

Before you leave, you receive a copy of your treatment summary and copies of your X-rays. Ask us which material was used for each crown, and keep this with your records. If your dentist has questions about the treatment, they can contact us on the same WhatsApp number; see aftercare and follow-up. What to do if a crown comes off is explained in our care guide.

How are crowns planned at Rönesans?

Prosthetics and aesthetic dentistry are among our clinic’s branches. At the examination the dentist assesses your teeth, gums, bite and any old crowns, and decides which material suits each tooth after any imaging needed; cone-beam CT (CBCT) is available when roots or implants need a closer look. You know from the start which dentist will treat you, and you receive a written plan that sets out the treatment tooth by tooth.

Impressions can be taken with an intraoral scanner, and crowns are made with CAD/CAM at the dental laboratory we work with. How many appointments this takes is explained in how many visits zirconia crowns take, and the treatment itself on our zirconia crowns page.

We are open Monday to Friday 10:00–22:00 and Saturday 10:00–19:00, Türkiye time. Send photos and X-rays on WhatsApp at +90 532 363 49 54, call our head office on +90 264 606 09 43 or use our contact page; during opening hours we reply in English and German within 15 minutes.