The primary goal of either monolithic or layered restorations is to reintegrate form, function, and esthetics with minimal damage and maximum longevity to the remaining natural dentition. Today's state-of-the-art technology available in both realms is capable of yielding from above average to excellent esthetic results. The clinical choice between one or the other can depend on several factors that include strength and esthetics and whether restoring the anterior or posterior segments. The layering porcelain that is stacked over the core of all restorations is the weakest link that gives "under shear" or flexural loads between 90 and 140 MPa. Because of high flexural strength (380-1,000 MPa), monolithic restorations are ideally indicated for stress-bearing areas and can be used as a single bulk material without the need for the weaker outer layer of stacked porcelain, especially in the posterior zone or in the form of short-span anterior or posterior bridges.

Most powder/liquid porcelains will present color and optical properties that most closely match that of natural dentin and enamel, which is an advantage over monolithic ceramics. The greatest challenge with monolithic restorations has been optimizing esthetic outcomes. Newer blocks and ingots that present improved color and optical properties minimize the use of surface stains. CAD/CAM technology now allows the milling of blocks that have a dentin-like color bulk (eg, CEREC^® Block PC), with more pronounced hue and chroma, topped with an enamel-like, more translucent layer. The milling can be adjusted to achieve the desired color result while final staining is still an option for further customization. This option is convenient in the posterior segment where esthetic challenges are not as great. Other CAM/CAM systems (eg, Lava^™ DVS) allow characterization to be applied internally, rendering the restoration more polychromatic and natural looking. Other monolithic systems now present a high-translucency coping material that precludes the use of a veneering layer due to improved optical characteristics (eg, e.max^® HT). This restorative option is particularly important in cases of anterior veneers on bruxers or where occlusion poses a challenge.

There is a wide range of all-ceramic choices. The outer esthetic layer can be accomplished with conventional powder and liquid porcelain or pressed over the ceramic coping. The latter seems to be gaining greater acceptance due to the ease of fabrication and precision of the marginal fit. Layered all-ceramic restorations comprise veneers, inlays/onlays/overlays, full crowns, and bridges. The principal difference in layered all-ceramic restorations lies in the ceramic used for the coping, which include zirconia, alumina, and lithium disilicate.