Choosing an all-ceramic restorative material - Porcelain-fused-to-metal or zirconia-based?

Use of zirconia-based all-ceramic crowns and fixed prostheses is rapidly growing. Zirconia-based crowns and fixed prostheses have undergone only a few years of basic science research and laboratory and clinical observation. To date, the research results are promising. However, significantly more clinical research is needed regarding this concept. These are my observations regarding zirconia-based all-ceramic restorations when compared with PFM restorations: They are better esthetically than typical PFM restorations. The long-term color stability probably will be the same as that observed with PFM restorations. The margins of the restorations have a more acceptable appearance than those of PFM restorations when gingiva recedes. Research shows that the strength and service record of PFM restorations and zirconia-based restorations in three-unit prostheses is similar, but longer clinical observation is necessary for final judgment. Prostheses requiring precision attachments or stress breakers are best made with PFM restorations. The long-term wear characteristics on opposing teeth for either material probably will be similar, because the external ceramic materials are similar. Gingival sensitivity to metal will be reduced or eliminated with use of zirconia-based restorations. The cost of zirconia-based restorations is higher than that of PFM restorations, but it probably will decrease as further developments take place. Overall, the potential for zirconia-based all-ceramic restorations appears to be very good.