Purpose: The aim of this study was to compare the clinical performance of metal-ceramic crowns made with an experimental alloy prepared by the Nordic Institute of Dental Materials, containing 15% zirconium and 85% titanium (Ti-15% Zr), and a high noble gold-palladium alloy (Mattikraft). Materials and Methods: Twenty patients who satisfied the inclusion criteria were selected sequentially from the departmental waiting list. Each patient received 2 crowns in the premolar or molar region. Which tooth was to receive a crown based on gold-palladium alloy or Ti-15% Zr alloy was randomly decided. A number of aspects indicating the clinical performance of the crowns were recorded at baseline and after 1, 2, and 3 years. Results: No statistically significant differences between the 2 types of crowns were demonstrated regarding overall technical evaluation, occurrence of plaque, bleeding on probing, or patient satisfaction. Periodontal pocket measurements around Ti-15% Zr crowns were significantly higher than those around gold alloy crowns. However, a similar difference also existed at baseline. Periodontal pocket measurements increased and patient satisfaction improved significantly over time. Conclusions: Within the limitations of this study, the results indicate that there is no difference in the clinical performance of crowns based on Ti-15% Zr or gold-palladium alloy. Int J Prosthodont 2008;21:312–318.