Porcelain-Fused-to-Metal and

All-Ceramic Crowns for

Posterior Teeth:
Material Science
and Laboratory
Procedures

Masayuki Saito, RDT1

Kimiyo Sawyer, RDT2

O
ver the last decade, laboratory procedures
have changed dramatically due to the intro-
duction of computer-aided design/computer-
assisted manufacture (CAD/CAM) technology. This
evo­lu­tion began with the use of zirconia as a base
material for dental restorations. Recently, the use of
CAD/CAM-fabricated full-contour zirconia (FCZ) crowns
for posterior teeth has become a popular restoration
option among large commercial laboratories. In con-
trast, porcelain-fused-to-metal (PFM), pressed lithium
disilicate (LD), and porcelain-fused-to-zirconia (PFZ)
crowns remain popular among smaller laboratories.
This article compares these four restoration types based
on their material science and laboratory procedures.

PFM Crowns
Master Ceramist, Cusp Dental Laboratory, Malden, Massachusetts,
Material Science
1

USA.
2
President, Cusp Dental Laboratory, Malden, Massachusetts, USA.
Properly constructed and seated PFM crowns provide
Correspondence to: Kimiyo Sawyer, Cusp Dental Laboratory,
optimal strength and longevity. An anatomical frame-
381 Pearl Street, Malden, MA 02148. Email: info@cuspdental.com work design is crucial to provide proper support and

QDT 2013 1
 SAITO/SAWYER
maintain the appropriate thickness for the veneering
porcelain.1–3
The following criteria are critical to proper fabrica-
tion1–3:
•  The coefficients of thermal expansion of the porce-
lain and alloy must be closely matched to achieve a
strong bond; otherwise, adhesive failure (eg, delam-
ination or fracture) may occur.
•  Proper casting temperature and timing are needed
to prevent overheating or miscasting. Excess gas in
the alloy can cause small surface pits and bubbles in
the veneering porcelain.
•  A smooth metal surface must be achieved via finish-
ing procedures to strengthen the bond with the ve-
neering porcelain.
•  It is important to avoid sharp angles or pits on the
veneering surface, which can lead to cracking due to
internal stress.
•  Heat treatment is necessary for degassing and to
create an oxide layer, which promotes a chemical
bond between the alloy and porcelain.
•  The use of an opaque layer as the first porcelain
coat is crucial for three reasons: (1) to ensure a strong
bond at the interface of the opaque porcelain and
alloy, (2) to mask the metal color, and (3) to provide
a base color for the targeted shade.2,3 When a satis-
factory opaque layer has been baked, the dentin
(body), enamel, and incisal (translucent) porcelain
layers can be applied to achieve the desired ap-
pearance.
The fabrication of PFM crowns involves many steps;
therefore, errors may occur. Nevertheless, more than 50
years of research, development, and clinical experiences
show that PFM crowns in the posterior region main­
tain a high survival rate (95%)4,5 with well-established
strength and reliability.
Laboratory Procedures
Laboratory procedures have changed dramatically since
the inception of CAD/CAM technology. Many large
laboratories now rely on high-end CAD/CAM systems.
In the beginning, CAD/CAM milling materials included
only all-ceramic options such as zirconia or glass blocks.
As the technology progressed, however, the milling
2 QDT 2013
capabilities expanded to include wax, composite res-
in, and cobalt-chromium alloy; further, some CAD/
CAM systems are now equipped with the printing ca-
pability to create an acrylic resin pattern for PFM cop-
ings and full cast restorations. Cobalt-chromium alloy
is particularly appealing because it is inexpensive and
highly biocompatible.
The laboratory is responsible for scanning the dies,
designing the virtual frameworks, and electronically
transferring the digital information to a printing facility.
The acrylic resin pattern provides a consistent thick-
ness and sufficient support for the porcelain. However,
these CAD/CAM systems do have limitations; it is of-
ten necessary to manually perform touch-ups and fin-
ish the margins with a wax-up to achieve an optimal
marginal seal before investing and casting. Despite
these imperfections, CAD/CAM technology is rapidly
progressing.
There are three basic layering porcelain powders:
dentin (body), enamel, and incisal (translucent). Dentin
and enamel layers control the color, while the incisal
layer provides translucency. When restoring anterior
teeth, all three powders must be used to achieve ac-
ceptable esthetics. However, newly developed enamel
porcelains (eg, EX-3 Speed Enamel, Kuraray Noritake,
Tokyo, Japan) offer higher translucency than conven-
tional enamel porcelain while remaining less translu-
cent than incisial porcelain. For posterior crowns, these
new enamel porcelains can be used in conjunction with
dentin porcelain to provide acceptable color and
trans­lucency in only two layers. This two-layer tech-
nique offers esthetic outcomes similar to those of the
more time-consuming three-layer technique (Fig 1).
The two-layer technique is also more suitable for en-
try-level ceramists due to its simplicity.
The opaque layer must be baked twice; the first thin
layer of wash bake ensures the bond strength between
the porcelain and metal, while the second layer covers
the entire metal surface to mask the dark color.2,3
One of the most challenging aspects of fabricating
PFM crowns is the high light reflection at the marginal
areas, which is caused by the lack of light transmission
through the metal. Therefore, controlling light reflec-
tion during layering is important for a successful es-
thetic outcome.2,3 An internal stain (EX-3 Internal Stain,
Kuraray Noritake) can be applied over the opaque
layer to control the light reflection. Internal staining
does not increase the thickness of the crown and is
 Porcelain-Fused-to-Metal and All-Ceramic Crowns for Posterior Teeth
1a
Figs 1a and 1b  Two-layer PFM crowns (left) and three-layer
PFM crowns (right). Note the similar esthetic outcomes.
Fig 2  Application of internal stain over the opaque layer to
control light reflection.
Fig 3  Two-layer build-up technique.
Translucent powder
Three-layer method Cutback line for two-layer method
3
ideal for use at the margins (Fig 2). When using the
two-layer approach, the amount of body porcelain
should be decreased with a cutback method, while the
amount of enamel porcelain should be increased to
enhance translucency (Fig 3).
PFZ Crowns
Material Science
Yttria-stabilized tetragonal zirconia polycrystal (Y-TZP)
ceramic is commonly used in dentistry. This material
1b
Speed Enamel
(translucent + enamel powders)
Two-layer method
offers high flexural strength and toughness as well
as chemical and dimensional stability due to its
transformation-toughening characteristics.6 The differ-
ent brands of Y-TZP available on the market show sim-
ilar coefficients of thermal expansion and other physi-
cal properties. Therefore, veneering porcelain from
one system can be applied to copings from other
manufacturers listed in Table 1. However, two or more
different porcelain powders should not be mixed dur-
ing application.
One of the unique features of Y-TZP is that its sur-
face structure transforms from a tetragonal to mono-
clinic phase at low temperatures with moisture.5 Flinn
et al7 found that this surface transformation triggered a
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 SAITO/SAWYER
Table Coefficient of Thermal Expansion (CTE) of
1 Different Ceramic Systems
Brand
Cercon (Dentsply, York, Pennsylvania, USA)
CEREC YZ (Sirona, Long Island City, New York, USA)
KATANA (Kuraray Noritake, Tokyo, Japan)
Lava (3M ESPE, St Paul, Minnesota, USA)
Prettau (Zirkonzahn, Gais, Switzerland)
Procera ZR (Nobel Biocare, Zurich, Switzerland)
*As specified by the manufacturers.
statistically significant decrease in the flexural strength
of thin bars of Y-TZP. Flexural strength differs among
various brands. Regardless, Y-TZP core materials have
not been problematic in clinical use.8 The bond be-
tween the zirconia core material and veneering porce-
lain differs from that of PFM crowns because zirconia
does not require an oxide layer for bonding. Thus, PFZ
restorations show better bond strength between the
core and veneering material than PFM restorations.6
This indicates that the bond strength may not be the
primary determinant of veneer failure for all-ceramic
zirconia restorations.
Chipping of the porcelain layer has been frequently
reported as a cause of failure (13% to 25% of fail-
ures).5,9
Blatz et al10 reported the outcomes of 2,635 posteri-
or crowns fabricated by the present authors’ laboratory
for a variety of private practitioners (14 prosthodon-
tists and 8 general dentists). This survey concluded
that the survival times and probabilities of PFZ crowns
(veneering layer: Cerabien ZR, Noritake) were statisti-
cally similar to those of PFM crowns.10 Another study
evaluated the remake ratios of 24,392 zirconia-based
porcelain crowns (23,787 Cerabien ZR crowns; 605
Lava Ceram crowns, 3M ESPE, St Paul, Minnesota,
USA) fabricated in a private laboratory. The overall re-
make ratio was less than 1%.11 The results showed that
the quality of the veneering porcelain greatly contrib-
uted to the success of the restoration.
Laboratory Procedures
Just as in PFM crowns, PFZ crowns consist of two dif-
ferent materials: the core porcelain and the veneering
4 QDT 2013
CTE*
10.5
10.5
10.5
10.0
10.6
10.4
porcelain. Also as in PFM crowns, the veneering mate-
rial is composed of feldspathic porcelain; however, the
coefficient of thermal expansion (CTE) is approximate-
ly 9 ppm for PFZ crowns as opposed to 14 to 15 ppm
for PFM crowns.1
The PFZ framework procedure is simpler than that
of PFM because it does not require additional proce-
dures to increase the bond strength. A chamfer prepa-
ration should be used at the margin, without a bevel or
knife-edge finish line, to support the ceramic structure
(Fig 4).12 Fine details of the framework design cannot
be confirmed until milling and sintering; therefore,
certain adjustments using a dental handpiece will be
required. Additional buildup is not possible. The mill-
ing unit has limited burs, which means the inside of
the coping usually needs further grinding to achieve
optimal fit to the die. When grinding zirconia with a
diamond bur and high-speed turbine, cooling water
supply is necessary because excess heat can lead to
microcracks at the coping surface and eventually to
fracture. The thermal conductivity of zirconia is lower
than that of metal alloy, which means PFZ crowns must
be heated up and cooled down slowly. It is important
to follow the manufacturer’s baking instructions (Table
2); otherwise, cracks or fractures may occur.6
The translucency of the zirconia core decreases
light reflection at the cervical area; thus, PFZ crowns
offer a more natural appearance compared to PFM
crowns. Unlike glass-ceramic, zirconia also offers a cer-
tain level of masking ability. Depending on the target-
ed shade, the color of an abutment tooth and the light
reflection at the cervical area can be controlled using
appropriate internal stains. PFZ crowns can be fabri-
cated using the same two-layer technique used for the
PFM crowns.
 Porcelain-Fused-to-Metal and All-Ceramic Crowns for Posterior Teeth

Fig 4  Ideal preparation

for PFZ posterior crowns. 1.5 to 2.0 mm

Taper between
5° and 15°

* * 1.0 to 1.5 mm

Table
Baking Instructions for PFM and PFZ Crowns*
2
Low Dry-out time High Hold time Cooling time
Material temperature (°F) (min) Heat rate (°F) temperature (°F) (min) (min)
PFM (EX-3) 600 7 45 930 0 0
PFZ (Cerabien ZR) 600 7 45 930 1 4
*To be used as a guideline only. Baking temperatures can vary by case and furnace.

Pressed LD Crowns
Material Science
Pressed LD has the highest flexural strength (400 MPa)
among the glass-ceramics used in prosthetic dentistry.
Clinical studies have shown excellent short-term re-
sults.8 Monolithic LD seems to be particularly well suit-
ed for posterior crowns.
The baking temperature of the feldspathic veneer-
ing porcelain is lower than that of many other types.
The high baking temperature of the dentin and incisal
porcelain is 750°C. In terms of the core material, the
press temperature of an LD ingot ranges from 910°C
to 930°C depending on the size and opacity. The ve-
neering porcelain must be baked at a temperature
well below the core ingot melting range. In contrast,
the veneering porcelain for PFM crowns has a much
higher baking temperature (910°C to 950°C). In gen-
eral, high-fusing porcelains are stronger than low-fusing
porcelains.3
When veneering porcelain is applied over LD, a thin
layer should be used to avoid possible chipping13; fur-
ther, the thickness of the core material must also be
reduced. Thus, the fracture strength of the bilayer LD
is affected by both the total specimen thickness and
core thickness.14 Pressed LD crowns require resin bond­
ing cementation to ensure sufficient strength and lon-
gevity.
Laboratory Procedures
In the authors’ commercial laboratory, trial tests were
performed before the actual procedures of the clinical
cases of pressed LD crowns. The results showed that
LD crowns (IPS e.max Press, Ivoclar Vivadent, Schaan,
Liechtenstein) were twice as strong as Leucite-reinforced
glass-ceramic crowns (IPS Empress, Ivoclar Vivadent)
and three times stronger than standard glass-ceramic
crowns (VITABLOCKS Mark II, VITA Zahnfabrik, Bad
Säckingen, Germany) (Table 3). As a result of these
findings, LD material replaced the earlier generations
of glass-ceramic materials.
The laboratory procedures for pressed crowns are
the same as for lithium disilicate or Leucite-reinforced

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 SAITO/SAWYER
Table
Mean Flexural Strength of Ceramic Restorations
3
Material Flexural strength (MPa)
Pressed LD (IPS e.max Press)
LD CAD block (IPS e.max CAD)
Leucite-reinforced glass-ceramic (IPS Empress)
Glass-ceramic (VITABLOCKS Mark II)
5a
glass-ceramic as long as the crown is fabricated prop-
erly using the lost-wax technique. The fit and final
anatomy are easy to manage. The acrylic resin pattern
created by the CAD/CAM system should be finished
manually by a technician to promote optimal fit and
marginal sealing. Due to the high flexural strength of
LD crowns, many clinicians who use chairside CAD/
CAM systems also use lithium disilicate blocks despite
the extra time required for sintering (Table 3).
Pressed LD crowns can be ideal for a simple-tone
tooth color as a shade guide, especially in the cervical
area. However, the high translucency of the final shade
will be affected by the underlying tooth (Fig 5). For
anterior restorations, it is important to create an extra
die using tooth-colored resin or wax to mimic the
6 QDT 2013
400
360
150
120
5b
Figs 5a and 5b  The translucency and color of an LD
crown can be influenced by the underlying tooth color,
especially the margin area.
Fig 6  Custom die fabricated using tooth-colored resin
or wax.
stump shade. The final color of the LD crown can then
be properly assessed (Fig 6). For posterior restora-
tions, these extra steps are rarely necessary, and PFM
or PFZ restorations should be used instead.
When fabricating LD crowns, selecting an ingot with
the appropriate value and chroma is important. When
the final shade is incorporated into the final appear-
ance of a pressed LD crown, a low-translucency (LT)
ingot should be used. The color of an LT ingot is simi-
lar to that of the dentin porcelain. The incisal area
needs to be lighter in shade than the cervical area;
therefore, an ingot with a lighter shade than the target
shade should be used for monolithic crowns. If the tar-
get shade is A2, a lighter-shade A1 ingot is usually ap-
propriate.
 Porcelain-Fused-to-Metal and All-Ceramic Crowns for Posterior Teeth

Fig 7  Transformation of zir-

conia from a tetragonal to a
monoclinic crystal structure. SEM

Hydrothermal condition:
180° C, 1 MPa × 5 h

Tetragonal

ZrO2 coping surface

Monoclinic crystal
structure
(20 ~ 30 µm)

Weakened strength

Table The Effect of Accelerated Aging on Flexural

4 Strength of Y-TZP7,17
Flexural strength, MPa (SD)
Brand Tetragonal Monoclinic
Lava (3M ESPE) 1,158.0 (88) 829.5 (71)
Prettau (Zirconzahn) 1,406.0 (243) 882.7 (91)
Zirprime (Kuraray Noritake) 1,126.0 (92) 976.0 (37)

FCZ Crowns Low-temperature degradation may be an issue over

Material Science
FCZ crowns, which are typically composed of 3-mol%
Y-TZP, are the fastest-growing restoration in terms of
popularity due to their slightly increased translucency
than the core material, efficiency, and affordability. A
previous clinical study showed that FCZ crowns on
molar teeth performed well after 1 year in service, with
no evidence of cracks, chips, or fractures.15 Another
clinical study of the wear of dentition opposing FCZ
crowns reported reduced wear rates compared to
those of regular feldspathic porcelain.16 However,
studies regarding the long-term durability of FCZ
crowns are still needed.
time. In clinical practice, the occlusal contact areas and
marginal areas tend to be thinner than the manufactur-
ers’ recommended range of 0.5 to 1.0 mm. As dis-
cussed earlier, Y-TZP surface transformation can lead
to lower flexural strength; however, this effect varies
among different brands of materials (Fig 7). In one
study, hydrothermal aging of Y-TZP caused a statisti-
cally significant decrease in flexural strength following
the transformation from a tetragonal to a monoclinic
crystal structure.10 Table 4 shows the effect of acceler-
ated aging on several brands of Y-TZP materials. Ad-
ditional clinical studies are needed to more fully un-
derstand this effect over the long term.7,17

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 SAITO/SAWYER
8a 8b
8c
Laboratory Procedures
In recent years, the majority of FCZ procedures have
been performed using a CAD/CAM system. However,
manual adjustment of the intaglio surfaces is often
necessary.
Crown shading is usually performed before sinter-
ing. Two shading methods are available for FCZ crowns:
monochromatic shading or multicolor shading using
the Lava Ceram system.
For monochromatic shading, a milled crown is soaked
in liquid dye to achieve a target shade of monochro-
matic color. After sintering, the crown is treated with
an external stain (Fig 8). For multicolor shading, two or
three different liquid dyes are applied with a brush at
specific areas of the milled crown before sintering. The
crowns are again completed with an external stain.
The color of an as-milled crown is solid, chalky white.
The dye is absorbed from the crown, and the color only
appears after sintering. Thus, establishing both the mix­
ing ratio of the liquid dye and the number of applica-
tions is crucial to achieve an optimal final color. The
external stain will have only a small effect on the color.
8 QDT 2013
Fig 8a  Milled crown soaked in liquid dye
to achieve the targeted shade for mono-
chromatic coloring.
Fig 8b  Multicolor dyeing before sintering.
Fig 8c  Monochromatic (left) and multi-
color (right) crowns after sintering.
Adequate occlusal reduction is necessary because
occlusal and marginal areas may experience excessive
stress and loading during service. Tight occlusal con-
tact involves a preparation with at least 0.5 mm of oc-
clusal space. For PFM this is crucial, as with less than
0.5 mm an undersirable spot of metal will show due to
lack of space for layering porcelain. Considering the
long-term function of a crown and the limitations of
CAD/CAM systems, it may be prudent to maintain at
least 0.5 mm of space at all aspects of the restoration
to avoid fractures.17
Case Report
This case report involves the fabrication a single crown
for a mandibular right first molar adjacent to two
healthy teeth. The case was received from a private
practitioner.
A chamfer margin preparation and appropriate oc-
clusal reduction had been carried out. Four crowns
were fabricated with four different materials for com-
parison in the patient’s mouth:
 Porcelain-Fused-to-Metal and All-Ceramic Crowns for Posterior Teeth

CASE report

9a 9b

10

Fig 9a  Comparison of translucency between ceramic crowns in more chromatic image. (left to right) PFM, FCZ, PFZ,
and pressed LD.

Fig 9b  Comparisons of translucency in the margin area. (left to right) Pressed LD, PFZ, and FCZ crowns.

Fig 10  First molar crowns fabricated using (left to right) PFM, PFZ, pressed LD, and FCZ on the casts.

1. PFM: Ceradelta 2 (silver-palladium alloy; Cendres+
Métaux, Bern, Switzerland) and EX-3 (Kuraray Nori-
take)
2. PFZ: Noritake Katana coping and Noritake Cera-
bien ZR
3. LD: IPS e.max Press (LT A1 ingot)
4. FCZ: Lava Plus
A shade of A2 was instructed by the dentist based
on the VITA Lumin shade guide (VITA Zahnfabrik).
Shade photographs, which are often sent to techni-
cians for anterior crowns, are not provided in posterior
cases. The crowns were fabricated following the man-
ufacturers’ instructions (Figs 9 and 10). Before the
crowns were tried in, each shade was confirmed as A2
using a dental spectrophotometer (Crystaleye, Olym-
pus, Tokyo, Japan).
Figures 10 and 11 show the differences between
the crowns on the casts and in the patient’s mouth. On
the casts, the cervical area of the pressed LD crown
appears to provide the best color match. The PFM
crown shows high brightness due to light reflection.
The PFZ and FCZ crowns look similar and show supe-
rior esthetics compared to the PFM crown. The incisal

QDT 2013 9
 SAITO/SAWYER

11

Fig 11  Occlusal (top), monochromatic (middle), and buccal (bottom)

views of the (left to right) PFM, PFZ, pressed LD, and FCZ crowns.

Fig 12  Confirming the selected shade at the final try-in stage.

12

areas of the feldspathic porcelain in the PFM and PFZ
crowns show better color than those of the LD and
FCZ crowns, which have monolithic material character-
istics. The value of a monolithic crown is the same over
the entire crown surface; therefore, the incisal areas of
the LD and FCZ crowns have a higher value than would
be ideal (Fig 11).
In the patient’s mouth, the PFM and PFZ crowns
show better shade matching than the two monolithic
crowns. Even though the A2 shade appeared accept-
able on the casts, the occlusal aspects of the LD and
FCZ crowns in the patient’s mouth appear to have a
higher value than the adjacent teeth. For mandibular
molar crowns, the occlusal surfaces are more visible
than the buccal surfaces, which makes occlusal shade
matching especially important (Fig 12). The use of
shade A1 for pressed LD crowns would result in exces-
sive value at the occlusal surface since the material is
solid in tone. Shade A2 should be used for optimal
color matching. The occlusal area of FCZ crowns can
be improved esthetically by increasing the chroma be-
fore sintering.
Conclusions
Understanding the material science and laboratory
pro­cedures of porcelain-fused-to-metal, porcelain-
fused-to-zirconia, lithium disilicate, and full-contour
zirconia crowns is a primary factor for successful restor-
ative treatment. Considering the range of options

10 QDT 2013
 Porcelain-Fused-to-Metal and All-Ceramic Crowns for Posterior Teeth
available on the market, dental technicians are chal-
lenged to master the techniques and technology nec-
essary to achieve long-term clinical success.
Acknowledgments
The authors extend special thanks to Drs Kimberly S. Weiss and
Miguel Vidal for their collaboration; Mr Yoshihisa Yamada and Mr
Toshio Sakakibara, Kuraray Noritake Dental, for their technical ad-
vice and material support; and Dr Mark Wang for his material sup-
port.
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