What is a porcelain-fused-to-metal crown? How is it different from an all-ceramic crown? Start with whether there is a metal layer｜證據鏈

What is a porcelain-fused-to-metal crown? How is it different from an all-ceramic crown? Start with whether there is a metal layer｜證據鏈

F-Units (fact ledger)

Each entry records source, confidence, basis, period, geo, and caveat. Basis hierarchy: law > official_statement > clinical_guideline > peer_reviewed > textbook.

• F1｜confidence: high｜basis: internal_dataset (S21, not a medical claim)｜period: GSC retention window (from 2025-03-22)｜geo: TW｜Topic-selection basis = reconciliation of search data from 14 clinic sites; exact-match impressions for query “烤瓷牙” were 8,863, from one source site . The query family containing the string “烤瓷” on that site totalled 14,942; this card uses the exact-match value, consistent with the queue page.｜caveat: impressions are property-level figures, not deduplicated traffic. Internal data; remove this entire entry during the publication conversion. The clinic-attachment evidence supports 1 clinic; do not add or remove entries.
• F2｜confidence: n/a｜basis: structural editorial organisation (editorial framework, S22, not a factual claim)｜geo: universal｜The following are the site's editorially defined explanatory structure, not external facts: ① the principle of not defining a colloquial term and instead cross-referencing official item names; ② the evidence-selection rule that numbers from different studies cannot be subtracted and direct comparisons within one study take priority; ③ classification and ordering of the six comparison dimensions; ④ the structural reading that “the monolithic route does not exist in this branch” follows from “PFM necessarily has a veneer layer” (the premise is F4's definition, not a study conclusion); ⑤ the canonical boundaries between this card and the crown-cost (KM-DENTAL-11), all-ceramic-crown-price (KM-DENTAL-44), all-ceramic-crown-regret (KM-DENTAL-37), and crown-basics (KM-DENTAL-23) cards; ⑥ editorial rules against material-selection advice and comments on any monetary amount.
• F3｜confidence: n/a｜basis: evidence-gap statement (editorial, not pending verification)｜geo: universal｜This search did not obtain citable evidence. The card therefore does not state: ① any amount, range, or market rate; ② a direct comparison of tooth reduction required by the two crown categories (no systematic review directly comparing the amount of dental-tissue removal was found); ③ absolute incidence of gingival discoloration, chipping, or metal allergy (the available literature presents group counts, event counts, or sensitization rates in selected populations, and the card does not calculate them); ④ Taiwan-specific PFM complication or survival statistics; ⑤ individual advice on which material is better for a person; ⑥ human-risk conclusions inferred from in-vitro or animal experiments (see F14). Note: a 2018 systematic review obtained in this search directly compared zirconia and metal-ceramic single crowns (PMID 30328190), but its population was implant-supported single crowns, different from this card's tooth-supported topic; its mechanism for esthetic-complication differences involved abutments, so it was not used to avoid cross-population extrapolation.
• F4｜confidence: high｜basis: official_statement (S1, NLM MeSH controlled vocabulary, not a clinical guideline)｜period: obtained on 2026-08-06 by E-utilities esummary query to db=mesh; verbatim match｜geo: universal｜MeSH entry Metal Ceramic Alloys (UI: D016876). Verbatim scope note: 「The fusion of ceramics (porcelain) to an alloy of two or more metals for use in restorative and prosthodontic dentistry. Examples of metal alloys employed include cobalt-chromium, gold-palladium, gold-platinum-palladium, and nickel-based alloys.」 Synonyms in the same entry include Porcelain-Metal Alloys, Metallo-Ceramic Alloys, and Metal Ceramic Restorations.｜caveat: MeSH is controlled vocabulary for literature indexing, not a clinical guideline and not Taiwan's legal item name. This card uses it only for the material definition and enumeration of alloy families, not for any efficacy or safety claim.
• F5｜confidence: high｜basis: official_statement (S2)｜period: approved 109-01-17 (approval no. 北市衛醫字第 1093010058 號); the PDF was independently downloaded for this card on 2026-08-06: HTTP 200, 411,466 bytes, SHA256 33588b87…f98183; verbatim checked with pdftotext -layout｜geo: TW｜Taipei City dental-fee schedule item 2-29. Item-name text: 「金屬瓷冠」「(PFM-陶瓷熔」「附金屬全冠)」; unit: 「每顆牙」. Announcement-content text includes: 「5.依鑄造用金屬不同及咬合面設計不同而有所差異。」「6.超重金屬費用另計。」｜caveat: this is an approved version for Taipei City only; other cities and counties issue their own notices. This card reproduces no amount from the table. Extraction-method statement: the table is a PDF grid; the item name wraps in the text layer according to column width (「金屬瓷冠」「(PFM-陶瓷熔」「附金屬全冠)」 are three lines, interleaved with text from other columns). The card restores the complete name from the same cell; each fragment was matched to the complete text individually with grep -F. A direct search for the combined string fails because of line breaks and does not mean a mismatch. 「6.超重金屬費用另計。」 occurs 2 times in the full table (2-28 and 2-29), so is not unique to this item.
• F6｜confidence: high｜basis: official_statement (S2)｜period: same as F5｜geo: TW｜Same schedule, item 2-30. Item-name text: 「全瓷牙冠」; unit: 「每顆牙」. Announcement-content text includes: 「5.依使用全瓷材料及製作方式不同而有所差異。」｜caveat: same as F5. This announcement-content sentence occurs 3 times in the table (also in other all-ceramic items), so is not unique to 2-30. This card uses it only to explain that the two are different items with different sources of variation in the approved document; it compares no monetary amount.
• F7｜confidence: high｜basis: official_statement (S2)｜period: same as F5｜geo: TW｜Other crown items in the same schedule are separately listed: 2-27 「鑄造冠」, 2-28 「鑲面鑄造冠」 (announcement content includes 「5.依鑄造使用金屬不同而有所差異。」), and 2-31 「治療性暫時冠」; all have unit 「每顆牙」.｜caveat: same as F5. This entry only establishes that crown items offer more than two options; it makes no judgment on any item's indication.
• F8｜confidence: high｜basis: peer_reviewed (systematic review and meta-analysis, PMID 41489982)｜period: search window 2014–2024; published 2026｜geo: universal｜span: 「Lithium-disilicate and zirconia-based all-ceramic SCs achieve five-year survival rates comparable to metal-ceramic crowns.」「Monolithic lithium-disilicate and monolithic zirconia crowns showed significantly fewer ceramic fractures and chipping compared to veneered alternatives.」｜caveat: a five-year estimate at population level; cannot be extrapolated to individual prognosis. Complete material-specific five-year survival figures belong canonically to KM-DENTAL-11 and are not repeated here. The comparator wording in the second sentence is “veneered alternatives”; the abstract does not list its categories one by one, and this card does not specify whether it includes metal ceramic. Version-timeliness check (2026-08-06): this is the current version in the Pjetursson/Sailer series (the search found no update), replacing the 2015 Dent Mater Part I (PMID 25842099). The 2015 conclusion that zirconia should not be a first choice was updated by this version, so it is not cited here.
• F9｜confidence: medium｜basis: peer_reviewed (randomized controlled clinical study, PMID 28736293)｜period: 5-year follow-up; published 2017 (ClinicalTrials.gov NCT02758457)｜geo: universal｜span: 「72 patients, who needed the covering of at least a molar and/or premolar, were included in the study. All teeth were endodontically treated, with absence of periapical lesion or active periodontitis. Ninety single crowns were made with zirconia or metal framework and covered with pressable veneering ceramics.」「One core fracture occurred in Zircad/Zirpress crowns and one metal ceramic crown was lost for root fracture. Chipping fracture of the veneering ceramic was detected in 2 metal-ceramic crowns and in 3 zirconia-based crowns.」「The present randomized controlled trial shows that the survival of zirconia-based and metal-based single crowns is similar over a follow-up period of 5 years. No significant differences in esthetic, functional and biological outcomes were demonstrated between the two groups. The main failure mode was the chipping fracture of the veneering ceramic in both materials.」｜caveat: one centre and 90 crowns; population limited to endodontically treated posterior teeth with no periapical lesion or active periodontitis. The zirconia comparator was veneered (an extra pressable porcelain layer), not monolithic all ceramic, so it cannot be read as “monolithic all ceramic versus PFM.” The abstract also reports estimated cumulative survival and estimated cumulative success figures with standard deviations, but does not label their measurement units; this card does not cite them, using only event counts and conclusions. The original “core fracture” is not further defined in the abstract (it may refer to framework/core fracture); this card retains the source term and marks it as undefined, without broadening or narrowing its scope. Version-timeliness check (2026-08-06): a search of the same author group and topic obtained no longer-follow-up report.
• F10｜confidence: medium｜basis: peer_reviewed (systematic review and network meta-analysis of controlled clinical trials, PMID 38211687)｜period: published 2024｜geo: universal｜span: 「Eligibility criteria included clinical studies reporting on MVL on antagonist's tooth up to 24 months following the permanent crown placement. From a total of 5697 articles, 7 studies reporting on 261 crowns for 177 subjects with 3 ceramic materials (Lithium disilicate, metal-ceramic, monolithic zirconia) were included. Among all, metal-ceramic and zirconia caused significantly higher enamel tooth wear on antagonist teeth, representing 82.5 µm [54.4; 110.6]) and 40.1 µm [22.2; 58.0]) more MVL than natural teeth group. In contrast, lithium disilicate showed only 5.0 µm [-48.2; 58.1]) more MVL than occurs on opposing natural teeth.」｜caveat: follow-up up to 24 months and only 7 studies; the authors themselves state that the number of studies was insufficient. The figures are differences in antagonist-tooth mean vertical loss versus the natural-teeth group, not wear of the crown itself. Its conclusion about material ranking differs from another 2026 meta-analysis (PMID 41590161); the side-by-side account and complete reading of three studies belong canonically to KM-DENTAL-37. This card cites only this paper and marks the evidence as not converged; it does not choose one. Same anchor and verbatim span as KM-DENTAL-37.
• F11｜confidence: medium｜basis: peer_reviewed (systematic review, PMID 42008751)｜period: literature search 2012–2023; published 2026｜geo: universal｜span: 「Crown preparation leads to irreversible dental tissue loss, which affects long-term restoration success.」｜caveat: this review compares dental-tissue preservation in vertical and horizontal preparation techniques and includes clinical, in-vitro, and narrative literature; its PROSPERO registration was retrospective. This card uses only the statement that crown preparation causes irreversible dental-tissue loss, not any conclusion about which preparation technique is superior, and does not use it to compare whether PFM or all-ceramic crowns require more reduction (no direct comparison was found; see F3). Same anchor as KM-DENTAL-37.
• F12｜confidence: medium｜basis: peer_reviewed (retrospective multicentre analysis, PMID 38123140)｜period: enrolment 2005–2019; published 2024｜geo: universal｜span: 「A total of 2730 of 169 834 tested patients met the inclusion criteria.」「The sensitization rates with confirmed allergic contact stomatitis in women (n = 444) were highest for metals (nickel 28.6%, palladium 21.4%, amalgam 10.9%)」「Allergic contact stomatitis to dental materials is rare.」｜caveat: population restriction is very strong—the denominator is patients patch-tested because contact allergy was suspected and confirmed to have allergic contact stomatitis, not the general population or the incidence among crown recipients. The data came from a German dermatology-department network (IVDK); participants were mainly women (81.2%) and people older than 40 (92.8%). The subject was dental materials as a whole (filling materials, oral implants, dentures, and others), not PFM crowns specifically.
• F13｜confidence: medium｜basis: peer_reviewed (authors describe it as a PRISMA systematic review; PubMed pubtype is Review, PMID 36079183)｜period: search 1995–2022; published 2022｜geo: universal｜span: 「Out of a total of 836 articles, only 21 studies were selected and analyzed according to PRISMA methodology.」「Most of the in vitro studies confirmed that Co-Cr alloys have a good cytocompatibility compared to Ni alloys.」「Regarding the in vivo studies, it appeared that Co-Cr could rarely cause sensitization, irritation, and allergic reactions. Reactions were mainly observed for people allergic to Co or Cr.」｜caveat: of the 21 included articles, 10 were in-vitro and 11 in-vivo studies, with small sample sizes. All comparisons between the two materials in this paper (Co-Cr cytocompatibility relative to nickel alloys in in-vitro studies, and the authors' statement that titanium-based materials performed better) remain only in this fact ledger for traceability and are not stated in the body or FAQ: relative material performance is clinical material-selection information, and putting it before readers could imply changing material. The body uses this entry only for the statement that Co-Cr sensitization is rare and gives no material recommendation.
• F14｜confidence: low｜basis: peer_reviewed (in vitro + animal study, PMID 41501222)｜period: published 2026｜geo: universal｜span: 「Co-Cr alloy specimens were subjected to a six-month immersion test in artificial saliva, followed by quantification of released ions via Inductively Coupled Plasma Mass Spectrometry. Cytotoxicity was assessed in human fibroblast cells, and systemic toxicity was evaluated in male mice (n = 20), divided into control and Co-Cr alloy released ions treated groups.」｜caveat: this entry only labels the evidence level and makes no human conclusion. The study was artificial-saliva immersion plus cell lines plus mouse experiments, not clinical research; its findings cannot be extrapolated to risk for intraoral patients. It is included so readers who encounter similar titles online can recognise the evidence layer (see F3 item 6). This entry was found in the version-timeliness check for F13 (search 2023–2026 found no new systematic review replacing F13).
• F15｜confidence: low｜basis: peer_reviewed (single-centre clinical study, not a systematic review, PMID 28383139)｜period: 90 days of observation after cementation; published 2019 (online first 2017)｜geo: universal｜span: 「It may also be seen in cases of teeth restored with cast dowels and porcelain-fused-to-metal (PFM) restorations.」「This research was conducted on 25 patients referred for cast dowel and PFM restorations. These restorations were manufactured from Ni-Cr alloys. Ninety days after cementing the fixed prosthodontic restorations, the abutment teeth (n = 61) were divided into a group with gingival discoloration (GD) (n = 25) and without gingival discoloration (NGD) (n = 36).」「The results of this study indicated that impairment of periodontal status of abutment teeth seemed to be related to the presence of gingival discolorations.」｜caveat: 25/61 is not an incidence—one centre, referred patients, restorations that also contained cast dowels (so the finding cannot be attributed to the crown alone), and only 90 days of observation. The source did not report it as an incidence, and this card does not calculate one. The alloy was nickel-chromium. The abstract's opening sentence contains a quoted term (amalgam tattoo); to keep the span machine-comparable, this card cites the following sentence instead, with no change in content.
• F16｜confidence: high｜basis: clinical_guideline (narrative review commissioned for the 2017 World Workshop, PMID 29926939)｜period: published 2018｜geo: universal｜span: 「Placement of restoration margins within the junctional epithelium and supracrestal connective tissue attachment can be associated with gingival inflammation and, potentially, recession.」「Restoration margins located within the gingival sulcus do not cause gingivitis if patients are compliant with self-performed plaque control and periodic maintenance.」｜caveat: narrative review, not meta-analysis; same anchor and verbatim span as KM-DENTAL-11, KM-DENTAL-23, and KM-DENTAL-37.
• F17｜confidence: low｜basis: peer_reviewed (narrative review, not a systematic review, PMID 35225978)｜period: literature range 1981-01 to 2021-09; published 2022｜geo: universal｜span: 「The margin of discrepancy results in the enhanced accumulation of dental biofilm, microleakage, hypersensitivity, margin discoloration, increased gingival crevicular fluid flow (GCF), recurrent caries, pulp infection and, lastly, periodontal lesion and bone loss, which can lead to the failure of prosthetic treatment.」｜caveat: narrative review, lower evidence level than the commissioned review in F16; the two must not be stated as if equivalent. This card uses it only for the consequence chain of a discrepant margin and does not cite its comparison of marginal-fit superiority among different materials (to avoid it being read as material advice).
• F18｜confidence: medium｜basis: peer_reviewed (systematic review, PMID 35348371)｜period: published 2022｜geo: universal｜span: 「From 151 studies selected for full-reading, 19 were considered eligible for this review. Artifacts caused by orthodontic appliances were well-documented, and stainless steel brackets were the materials most likely to cause artifacts in MR imaging of head and neck. The literature was scarce for dental implants and restorations.」「Data regarding dental implants and prosthodontics restorations were inconclusive. The severity of artifacts in MRI and their influence on diagnosis is dependent on dental material features, location in the oral cavity, and magnetic resonance parameters.」｜caveat: the review assessed bias with QUADAS-2 and evidence quality with GRADE. For prosthodontic restorations, its conclusion was insufficient and inconclusive data; this card does not extrapolate “orthodontic appliances cause artifacts” to crowns.
• F19｜confidence: low｜basis: peer_reviewed (narrative review/update, not a systematic review, PMID 41996146)｜period: published 2026｜geo: universal｜span: 「A dental consultation is necessary before any head and neck MRI is performed to avoid unwanted effects of dental restorations, such as artifacts in the area of interest or radiofrequency-induced heating of the dental material.」｜caveat: narrative review, not a systematic review. This recommendation concerns workflow for clinical and imaging teams, not a direction for readers to decide themselves to remove or replace a restoration. It is presented alongside F18's “data for prosthodontic restorations are insufficient and inconclusive”; their evidence levels differ and this card does not merge them.
• F20｜confidence: high｜basis: law (S18)｜period: current text (independently tested for this card on 2026-08-06: HTTP 200; verbatim match)｜geo: TW｜Article 21 of Taiwan's Medical Care Act. Official English rendering: “Standards for medical fees charged by the medical care institution shall be determined by the municipal or county(city)competent authority.”
• F21｜confidence: high｜basis: law (S19)｜period: current text (independently tested for this card on 2026-08-06: HTTP 200; verbatim match)｜geo: TW｜Article 81 of Taiwan's Medical Care Act. Official English rendering: “When treating the patient, the medical care institution shall inform the patient or his/her legal agent, spouse, kin, or interested party of his/her condition, course of treatment, disposition, medication, expected condition, and possible ill effects.”
• F22｜confidence: high｜basis: law (S20)｜period: current text (independently tested for this card on 2026-08-06: HTTP 200; verbatim match)｜geo: TW｜Paragraph 2, Article 87 of Taiwan's Medical Care Act. Official English rendering: “Publications of new medical knowledge or research results, health education for patients, or academic publications which do not involve solicitation for medical practices shall not be regarded as advertisements for medical care.” This is the basis for the card's compliance notice.
• F23｜confidence: high｜basis: law (S17)｜period: current text (independently tested for this card on 2026-08-06: HTTP 200; verbatim match)｜geo: TW｜Subparagraph 11, Article 51 of Taiwan's National Health Insurance Act. Official English rendering: “Dentures, artificial eyes, spectacles, hearing aids, wheelchairs, canes, and other treatment equipment not required for positive therapy.”
• F24｜confidence: high｜basis: official_statement (S16, cross-card verified fact, same anchor)｜period: tested with ego-browser on 2026-08-05 (OP re-verified)｜geo: TW｜Neither of the two search paths' item categories on the National Health Insurance Administration medical-device comparison website includes dentistry; the full page text has no 「牙」 character.｜caveat: this card did not repeat the test; it uses the record in km-compliance/VERIFIED-FACTS.md. The official database can change; cite the verification date.

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Compliance notice

This is health education information under Article 87 of Taiwan's Medical Care Act.[F22] It is not medical advertising, does not recommend a particular institution, does not compare or endorse any material brand, and gives no amount or price range. Metal-ceramic and all-ceramic crown treatment both involve irreversible tooth preparation, medical risks, and contraindications. Possible events include veneering-ceramic chipping, framework or root fracture, gingival inflammation or discoloration, recurrent caries, metal-related allergic reactions, antagonist-enamel wear, and imaging artifacts. Actual treatment methods and outcomes vary by person and must be assessed by a dentist. The comparison dimensions compiled here are for communication when seeking care; they cannot replace clinical diagnosis or justify independently changing material, removing a restoration, or delaying care. This card gives no legal opinion on insurance claims or contract terms; those questions depend on the policy and contract wording.

Sources

All retrieval dates are 2026-08-06. PubMed entries were retrieved with E-utilities efetch (rettype=abstract) for verbatim abstract comparison, and pubtype in esummary was checked entry by entry for retraction status (all 12 had no Retracted Publication tag and no WITHDRAWN title). Statutes were retrieved from the National Laws and Regulations Database by curl (HTTP 200), and the text blocks were compared verbatim. The Taipei fee-schedule PDF was independently downloaded for this card by curl (HTTP 200; byte count and SHA256 in S2), then extracted with pdftotext -layout for verbatim comparison. The MeSH entry was retrieved with E-utilities esummary (db=mesh) for verbatim scope-note comparison.

• S1 U.S. National Library of Medicine, Medical Subject Headings: Metal Ceramic Alloys (MeSH Unique ID D016876). meshb.nlm.nih.gov record/ui?ui=D016876 (retrieved 2026-08-06; the card's retrieval route was NCBI E-utilities esummary db=mesh; scope note and synonyms matched verbatim)
• S2 臺北市醫療機構牙科收費標準表 (Taipei City medical-institution dental-fee schedule; approved version 1090117), PDF attachment; approval no. 北市衛醫字第 1093010058 號. www-ws.gov.taipei attachment (retrieved 2026-08-06; curl HTTP 200; 411,466 bytes; SHA256 33588b870c60b5b4a7fabf7d91806f7ad03197214c33638b12c17ef3f5f98183; item names and announcement-content columns matched verbatim)
• S3 Taipei City Department of Health—fee-standard page (source page for S2). health.gov.taipei fee standards (cross-card verified; KM-DENTAL-11/23 accessed it with ego-browser on 2026-08-06; this card instead verified the attachment directly)
• S4 Pjetursson BE, Pitta J, Balet A, Bjarnadottir GR, Sailer I, Romandini P. A Systematic Review and Meta-analysis Evaluating the Survival, Failure, and Complication Rates of Metal-Ceramic, Veneered, and Monolithic All-Ceramic Tooth-Supported Single Crowns-Part 1. Int J Prosthodont. 2026;39(3):308-324. PMID 41489982. pubmed.ncbi.nlm.nih.gov/41489982
• S5 Monaco C, Llukacej A, Baldissara P, Arena A, Scotti R. Zirconia-based versus metal-based single crowns veneered with overpressing ceramic for restoration of posterior endodontically treated teeth: 5-year results of a randomized controlled clinical study. J Dent. 2017;65:56-63. PMID 28736293. pubmed.ncbi.nlm.nih.gov/28736293
• S6 Mao Z, Beuer F, Hey J, Schmidt F, Sorensen JA, Prause E. Antagonist enamel tooth wear produced by different dental ceramic systems: A systematic review and network meta-analysis of controlled clinical trials. J Dent. 2024;142:104832. PMID 38211687. pubmed.ncbi.nlm.nih.gov/38211687
• S7 Florescu ML, Arrien-Barrenetxea G, Fiorillo L, et al. Preservation of Dental Structure in Prosthetic Restorations: Vertical and Horizontal Preparation Techniques. Systematic Review. Clin Exp Dent Res. 2026;12(2):e70360. PMID 42008751. pubmed.ncbi.nlm.nih.gov/42008751
• S8 Forkel S, Schubert S, Corvin L, et al. Contact allergies to dental materials in patients. Br J Dermatol. 2024;190(6):895-903. PMID 38123140. pubmed.ncbi.nlm.nih.gov/38123140
• S9 Grosgogeat B, Vaicelyte A, Gauthier R, Janssen C, Le Borgne M. Toxicological Risks of the Cobalt-Chromium Alloys in Dentistry: A Systematic Review. Materials (Basel). 2022;15(17):5801. PMID 36079183. pubmed.ncbi.nlm.nih.gov/36079183
• S10 Yahya AA, Hosny G, El-Banna SG, Alsakhawy SA. Toxicological Assessment of Cobalt-Chromium Dental Alloys: Ion Release, Cytotoxicity, and Possible Systemic Effects. Biol Trace Elem Res. 2026;204(6):3878-3895. PMID 41501222. pubmed.ncbi.nlm.nih.gov/41501222 (in-vitro and animal study; used only to label evidence level)
• S11 Ristic L, Dakovic D, Postic S, Lazic Z, Bacevic M, Vucevic D. Clinical Characteristics of Abutment Teeth with Gingival Discoloration. J Prosthodont. 2019;28(1):e45-e50. PMID 28383139. pubmed.ncbi.nlm.nih.gov/28383139
• S12 Ercoli C, Caton JG. Dental prostheses and tooth-related factors. J Periodontol. 2018;89 Suppl 1:S223-S236. PMID 29926939. pubmed.ncbi.nlm.nih.gov/29926939
• S13 Srimaneepong V, Heboyan A, Zafar MS, et al. Fixed Prosthetic Restorations and Periodontal Health: A Narrative Review. J Funct Biomater. 2022;13(1):15. PMID 35225978. pubmed.ncbi.nlm.nih.gov/35225978
• S14 Bohner L, Hanisch M, Sesma N, Blanck-Lubarsch M, Kleinheinz J. Artifacts in magnetic resonance imaging caused by dental materials: a systematic review. Dentomaxillofac Radiol. 2022;51(6):20210450. PMID 35348371. pubmed.ncbi.nlm.nih.gov/35348371
• S15 Agarwal P, Reddy GS, Singh K, Gangadharappa P, Rashid N, Jain K. Applications of magnetic resonance imaging in dentistry and material compatibility: an update. Gen Dent. 2026;74(3):72-77. PMID 41996146. pubmed.ncbi.nlm.nih.gov/41996146
• S16 National Health Insurance Administration medical-device comparison website, item categories in two search paths (cross-card verified fact, same anchor). info.nhi.gov.tw INAE2000/INAE2010S01 (tested with ego-browser and OP-reverified on 2026-08-05; record in km-compliance/VERIFIED-FACTS.md; this card did not repeat the test)
• S17 Taiwan National Health Insurance Act, Article 51 (Laws and Regulations Database). law.moj.gov.tw pcode=L0060001 flno=51 (retrieved 2026-08-06; HTTP 200; subparagraph 11 matches verbatim). Official English edition: law.moj.gov.tw/ENG pcode=L0060001. The Chinese text is authoritative.
• S18 Taiwan Medical Care Act, Article 21 (Laws and Regulations Database). law.moj.gov.tw pcode=L0020021 flno=21 (retrieved 2026-08-06; HTTP 200; text matches verbatim). Official English edition: law.moj.gov.tw/ENG pcode=L0020021. The Chinese text is authoritative.
• S19 Taiwan Medical Care Act, Article 81 (Laws and Regulations Database). law.moj.gov.tw pcode=L0020021 flno=81 (retrieved 2026-08-06; HTTP 200; text matches verbatim). Official English edition: law.moj.gov.tw/ENG pcode=L0020021. The Chinese text is authoritative.
• S20 Taiwan Medical Care Act, Article 87 (Laws and Regulations Database). law.moj.gov.tw pcode=L0020021 flno=87 (retrieved 2026-08-06; HTTP 200; paragraph 2 matches verbatim). Official English edition: law.moj.gov.tw/ENG pcode=L0020021. The Chinese text is authoritative.
• S21 Internal data: topic row in `km-production-queue.html`, section 3, clinic-topic table + complete GSC `__web__full.tsv` (data window 2025-03 through 2026-08), exact-match query reconciled line by line. Not a medical-fact basis; used only for topic selection and excluded from the visible layer at publication.
• S22 Editorial framework (no external source): the six comparison dimensions in this card; canonical boundaries with four cards in the same family; handling principle for colloquial terms; rule against subtracting across studies; and editorial rule against material-selection advice. See F2 and F3.

Internal citation chain

• Terminology routing card (read first): What are a denture and a dental crown? Can a missing tooth receive a crown? First see whether your root is still there (KM-DENTAL-23, draft). Boundary: that card covers “do I need a crown, is the root still there, and how do crowns, bridges, and implants differ?” This card covers “I have already decided to receive a crown but do not know the difference between PFM and all ceramic.” The two share the Taipei fee-schedule item-name anchor (this card additionally verifies announcement-content columns for 2-29 and 2-30).
• Fee canonical card: How much does one dental crown cost? If root-canal treatment or a large cavity led to a crown recommendation, read the quotation first (KM-DENTAL-11, draft). Boundary: full material-specific five-year single-crown survival figures, quotation breakdown, and reconciliation method belong to that card. This card keeps one population-level summary and points back; it gives no amount.
• All-ceramic-crown price card: How much does one all-ceramic crown cost? Why can two quotations differ greatly when both say “all ceramic”? (KM-DENTAL-44, draft). Boundary: internal material subdivisions within all ceramic (lithium disilicate, zirconia, yttrium content, and translucency) and reasons for different prices under the same name belong to that card. This card does not repeat all-ceramic internal classification.
• All-ceramic-crown drawbacks card: Will I regret an all-ceramic crown? What are the drawbacks? Match online complaints to the literature, category by category (KM-DENTAL-37, draft). Boundary: side-by-side account of three antagonist-wear studies, chipping morphology, evidence on bruxism, and expectation gaps belong to that card. This card cites only one antagonist-wear study and marks the evidence as not converged; it points back for the rest. The cards share the F10 (PMID 38211687), F11 (PMID 42008751), and F16 (PMID 29926939) anchors, with identical English spans.
• Dislodgement-response card: My denture/crown came off. Can I glue it back myself? (KM-DENTAL-38, draft). If your question is not “what is the difference?” but “it came off,” go directly to that card. Whether the material is PFM or all ceramic does not change the immediate response principle.