Differences in Volumetric Tooth Loss for Monolithic Ceramic Crowns, Occlusal Overlays, and Partial-Coverage Onlays

To compare the volumetric loss of clinical crown structure in commonly encountered clinical situations for monolithic ceramic crowns, occlusal overlays, and partial-coverage onlays.

Typodont teeth made with preexisting mesio-occlusodistal (MOD) preparations for mandibular first molars and maxillary first premolars were prepared with three different preparations: a full-contour monolithic zirconia crown, a lithium disilicate occlusal overlay, and mesio-occlusodistobuccal/mesio-occlusodistolingual (MODB/MODL) lithium disilicate onlays for premolars and molars. 3D-metrologic software was used to evaluate the volumetric loss of clinical crown structure for each preparation type. Subsequently, the mesiolingual cusps of mandibular molars and buccal cusps of maxillary premolars were excluded for a separate analysis to simulate patient presentation with an existing restoration and sheared-off cusp.

Full-coverage monolithic zirconia crowns removed 45.37 to 219.53 mm3 of the remaining clinical tooth structure, depending on the clinical scenario and tooth position, while lithium disilicate overlays removed 27.48 to 105.13 mm3 and MODB/MODL lithium disilicate onlays removed 5.48 to 47.45 mm3. In each scenario tested, MODB/MODL onlays removed significantly less clinical crown structure than overlays (P < .001); both MODB/MODL onlays and overlays removed significantly less structure than full-coverage crowns (P < .001).

Monolithic zirconia crown restorations require significantly more removal of remaining tooth structure than lithium disilicate occlusal overlays and partial-coverage onlays for commonly occurring clinical situations requiring indirect restorations.