Porcelain-fused-to-metal (PFM) was the most common indirect restoration before CAD/CAM ceramics arrived, according to the ADA. Zirconia now does much of the same work with less reduction and no metal, so it is fair to ask whether PFM still belongs on your Rx pad in 2026.
It does, in fewer and more specific cases. Below are the 2026 survival data, manufacturer prep requirements, the ADA alloy classes and a case-by-case guide.
Key Takeaways
- Single crowns are a tie: five-year survival is 97.1% for metal-ceramic, 96.8% for monolithic zirconia and 97.3% for veneered zirconia (2026 systematic review).
- For tooth-supported bridges, five-year survival was 91.3% for metal-ceramic, 92.9% for veneered zirconia and 87.9% for monolithic zirconia, with no significant difference.
- High-strength monolithic zirconia can be 0.5 mm thick on a posterior crown. A PFM needs at least 0.3 mm of metal plus 0.8 mm of porcelain.
- Ivoclar and Kuraray Noritake limit their high-strength zirconia bridges to 2 pontics. Longer spans are where PFM still earns its place.
- Alloy class matters: high noble means at least 60% noble metal with at least 40% gold, and 10% to 20% of people have a nickel sensitivity.
Quick Answer
For most single crowns, zirconia is the better default: five-year survival matches PFM (96.8% for monolithic zirconia vs. 97.1% for metal-ceramic), it needs less reduction, and monolithic zirconia chips least. PFM still makes sense for bridges with more than two pontics, some implant-supported bridges, matching existing PFM work, patients who need a specific alloy, and clinicians with a proven PFM protocol. Layered zirconia suits esthetic cases that also need strength.
How Do PFM and Zirconia Compare on Survival?
Two 2026 systematic reviews by Pjetursson, Sailer and colleagues cover 64 studies of single crowns and 41 of bridges. For single crowns, five-year survival was 97.1% for metal-ceramic, 97.3% for veneered zirconia and 96.8% for monolithic zirconia. For bridges it was 91.3%, 92.9% and 87.9%, with no significant differences among the three.
That is a real change. In 2015 the same group advised against zirconia-based single crowns as a primary option because of technical problems, including veneer fractures. Monolithic designs solved much of that: in 2026, monolithic crowns showed significantly fewer fractures and chips than veneered ones.
| Criterion | PFM | Monolithic zirconia | Layered zirconia |
|---|---|---|---|
| 5-year survival, single crowns | 97.1% | 96.8% | 97.3% |
| 5-year survival, tooth-supported bridges | 91.3% | 87.9% | 92.9% |
| Main technical risk | Porcelain chipping, 2.6% at 5 years | Least chipping of the three | Veneer chipping |
| Minimum thickness (manufacturer) | 0.3 mm metal plus 0.8 mm porcelain | 0.5 mm (high-strength) to 1.0 mm (translucent), posterior | Zirconia core plus porcelain layer |
| Margin | Metal collar (chamfer) or porcelain (shoulder) | Zirconia | Zirconia or porcelain shoulder |
| Bridge limits | Connectors sized to the alloy | 2 pontics (high-strength); 3 units (translucent) | Limits of the zirconia used |
| Extra wear on opposing enamel, up to 24 months | 82.5 µm | 40.1 µm | Not reported |
Where Does Each One Fail?
Chipping is the classic PFM complication, at a modest rate: the ADA cites 2.6% of PFMs chipping within five years. In the 2015 reviews, veneered zirconia had more veneer and ceramic fractures than metal-ceramic, while five-year framework fracture on bridges was 0.6% for metal-ceramic and 1.9% for zirconia. In 2026, chipping on bridges was least frequent with monolithic zirconia, but all-ceramic bridges as a group had more marginal caries and loss of retention than metal-ceramic.
A randomized trial followed 3- to 5-unit posterior bridges for 10 years: survival was 100% for metal-ceramic and 91.3% for veneered zirconia, which had more framework fractures, debonding and major veneer fractures. Those were veneered frameworks, not today's monolithic zirconia, but in bridges metal-ceramic has the longer track record.
Estimated 25-year survival of favorably rated high gold PFM crowns in one specialist practice (Walton, 2013). Of 2,340 crowns, only 4 were replaced for porcelain fracture.
How Long a Bridge Can Zirconia Handle?
Here the manufacturer label decides. Ivoclar lists its high-strength IPS e.max ZirCAD LT and Prime for bridges of four or more units with a maximum of 2 pontics, and its more translucent MT for crowns and 3-unit bridges. Kuraray Noritake limits KATANA ML and HT to 2 pontics and 1 cantilevered pontic, and does not recommend its translucent grades for bridges of four or more units. Posterior ML and HT bridges need connectors of at least 9 mm², and 12 mm² where two pontics join.
The maximum number of pontics Ivoclar and Kuraray Noritake list for their high-strength zirconia bridges. A span that needs more is outside the label.
When a span needs three or more pontics, or the connectors cannot get that much height, we discuss a metal-ceramic framework with you.
Implant-supported bridges
A 2018 systematic review found five-year survival of 98.7% for metal-ceramic implant bridges and 93.0% for veneered zirconia, and called metal-ceramic the standard. No monolithic zirconia implant-bridge studies qualified, so monolithic zirconia is a possible alternative with less long-term data.
How Much Reduction Does Each Need?
Ivoclar's 2024 instructions for its IPS Style Ceram metal-ceramic porcelain call for at least 0.3 mm of metal on single crowns, 0.5 mm on bridge abutments, and 0.8 to 1.7 mm of porcelain. Its example prep allows 2.0 mm over the cusps and incisal edge, 1.5 mm axially and at least 1.1 mm at the margin, with a stump at least 3 mm high for conventional cementation.
Monolithic zirconia needs much less: Kuraray Noritake lists 0.5 mm walls for posterior crowns in KATANA ML and HT, and 1.0 mm in its translucent grades.
For PFM margins, Ivoclar describes a chamfer as suitable for metal margins, while a porcelain margin requires a shoulder and should not be beveled. In a laboratory test, PFMs with metal margins withstood significantly higher loads than PFMs with circumferential porcelain margins.
Which Alloy: High Noble, Noble or Base Metal?
The ADA classifies alloys by their content of gold and platinum group metals, and the class sets the CDT code you report.
| Alloy class | Composition (ADA) | CDT crown code |
|---|---|---|
| High noble | At least 60% noble metal, gold at least 40% | D2750 |
| Noble | At least 25% noble metal | D2752 |
| Predominantly base metal | Less than 25% noble metal | D2751 |
| Titanium | Titanium at least 85% | D2753 |
Nickel-chromium and cobalt-chromium are the most common base alloys. The ADA notes that their hardness complicates adjustments and that 10% to 20% of the population has a nickel sensitivity, although oral reactions are rarer. Zirconia has not been linked to sensitivity or allergic responses. Alloy is also a cost lever: the ADA notes that by 1980 rising gold prices had driven the development of base metal alloys. For fee trends, see Dental Prices Then and Now.
What About Esthetics: Gray Margins and Opacity?
A PFM's metal has to be hidden: Ivoclar describes opaquers as opaque ceramic materials that mask the metal framework. At the gingiva, extended metal frameworks can cause what Magne and Belser called an "umbrella effect," with gray marginal gingiva and dark papillae. They called collarless PFMs the most successful esthetic evolution of metal-ceramic. Esthetics also drive replacement: in Walton's series, 22 crowns were replaced for esthetic complaints after a mean of 14 years.
Zirconia has no metal, but strength and translucency trade off. Kuraray Noritake rates its high-strength ML and HT at 1,125 MPa with 31% light transmittance, and its most translucent UTML at 557 MPa with 43%. Layered zirconia puts porcelain over the core; the ADA notes framework zirconia is veneered because of its opacity. For anterior cases, see Zirconia vs. E.max.
When Does PFM Still Make Sense?
- Bridges with more than two pontics, or connectors too short for zirconia.
- Implant-supported bridges, where metal-ceramic has the longest record.
- Matching existing PFM work.
- A proven clinician protocol: high gold PFMs reached about 97% survival at 10 years in Walton's series.
- A specific alloy request.
Which Should I Choose? A Decision Guide
| Case | Our usual recommendation |
|---|---|
| Single posterior crown | Monolithic zirconia |
| Less than 2 mm occlusal clearance | Monolithic high-strength zirconia |
| Anterior crown, margin visible | Layered zirconia or e.max; PFM only with a porcelain margin |
| 3-unit posterior bridge | Monolithic zirconia or PFM |
| Bridge with more than 2 pontics | PFM |
| Implant-supported bridge | PFM or monolithic zirconia; call us to plan |
| Next to existing PFMs | PFM in the same alloy class |
| Nickel-sensitive patient | Zirconia, or a PFM alloy labeled nickel-free |
| Regular head and neck MRI expected | Zirconia or precious-alloy PFM |
Unsure? Send the scan and call us before you prep. For why crowns come back, read Crown Remakes: What Really Causes Them.
PFM and Zirconia at Elegant Dental Laboratory
- We make both PFM and zirconia restorations: PFM options and zirconia options.
- Every case is made in house, no outsourcing, by more than 35 technicians in our 7,000 sq. ft. facility at 2308 McDonald Ave, Brooklyn, NY. Gary Fingerman founded the lab in 2007.
- 5 business day standard turnaround on most restorative cases, rush options available, and up to a 7-year warranty on final restorations (policies and warranties).
- Digital scans are reviewed before production. Send a case, submit a digital case or call 877-335-5221.
Related Guides
- Types of Zirconia Explained: 3Y, 4Y, 5Y, Multilayer, Monolithic and Layered
- Then and Now: How Crowns Went From Hammered Gold to Zirconia
- Crown Prep Guide: Reduction, Margins and Taper for Zirconia, E.max and PFM
FAQ
Are PFM crowns outdated?
No. Five-year survival of metal-ceramic single crowns (97.1%) matches monolithic zirconia (96.8%), and PFM remains a sound choice for long bridges and implant bridges.
Do PFMs chip more than zirconia?
More than monolithic zirconia, which chips least. The ADA cites 2.6% of PFMs chipping within five years.
What does "high noble" mean?
At least 60% noble metal with at least 40% gold, per the ADA. The crown is reported as D2750.
Why do some PFMs show a gray gumline?
Metal at the margin can show as a collar or gray the gingiva. A porcelain margin on a shoulder avoids the collar.
Can I use PFM for an implant bridge?
Yes. A 2018 systematic review found 98.7% five-year survival for metal-ceramic implant bridges.
Sources (17)
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Reviewed by Gary Fingerman, founder and CEO of Elegant Dental Laboratory, Brooklyn, New York (founded 2007). Last reviewed: September 28, 2026. Material values are manufacturer data or published studies; always follow the current instructions for use of the material you choose.
