Porcelain-fused-to-metal (PFM) crowns have been considered the gold standard for the repair of damaged teeth. PFM crowns have good mechanical properties, satisfactory esthetic results, and an acceptable biological quality needed for periodontal health. However, PFM crowns have some limitations that may limit their use. For example, the esthetic of PFM crowns is limited by the metal framework and the layer of opaque porcelain needed for masking the underlying metal grayish shade. Recently the cost of precious metals has risen markedly making PFM relatively unattractive from an economic standpoint.
All-ceramic crowns have been used over the last four decades as an alternative for PFM crowns to overcome their esthetic limitations. All-ceramic crowns can be made from different types of ceramic, and not all ceramic types have the same physical and esthetic proprieties. Historically, resin-based crowns were the first metal-free crowns to be used, but they were abandoned because of their low fracture resistance. Newer metal-free crowns are increasingly being used in dental practice; these crowns are made from different ceramic materials such as lithium disilicate, zirconia, leucite-reinforced glass, and glass-infiltrated alumina.
Policy makers require information on the relative benefits and costs associated with different types of crown materials in order to support reimbursement decisions. The objective of this review is to evaluate the clinical and cost-effectiveness of dental PFM and all-ceramic crowns.
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