Purpose: The aim of this clinical simulation study was to investigate the effect of anatomic and nonanatomic occlusal preparation design on stress distribution in different metal-ceramic crowns and tooth and bone. Materials and Methods: For the finite element analysis method, a 2-dimensional mathematical model of a mandibular second premolar tooth and its supporting tissues was used. The analysis was performed by using a structural analysis program. Four groups were designed: gold-palladium alloy/anatomic occlusal preparation (Au-Pd/A), Au-Pd alloy/nonanatomic (flat) occlusal preparation (Au-Pd/N), nickel-chromium alloy/anatomic occlusal preparation (Ni-Cr/A), and Ni-Cr alloy/nonanatomic occlusal preparation (Ni-Cr/N). A distributed type load of 400 N (total) was applied to the centric stop points on the tip of the buccal cusp and on the central developmental groove in centric occlusion to all types of restorations. Results: The results demonstrated that shear stresses in the dentin tissues and restorations in Au-Pd/A and Ni-Cr/A were similar. The shear stresses within the restorations in Au-Pd/N and Ni-Cr/N were similar. Conclusion: Anatomic occlusal preparation designs were advantageous in stress distribution in the dentin tissue. Nonanatomic occlusal preparation designs were found to be advantageous in the stress amount and distribution in the porcelain structure. Occlusal preparation designs and restorative materials showed no differences in stress distribution and amount in the pulp tissue and bone tissues.