We thought about your case quite a bit, and actually started 3 or 4 different responses to you question, but finally decided that there are really just too many variables involved that we know nothing about to add much of value to the conversation.

Like you, we can envision several scenarios where a minimal reduction onlay or crown might offer a solution. (Both of these types of restorations would require the same amount of chewing surface reduction.)

It certainly seems reasonable that you might suggest the idea of a BruxZir (zirconia) restoration to your dentist so they can explain to you why it doesn't make an acceptable solution. (As your dentist, that's really a part of their obligation to you.)

Monolithic zirconia crowns/onlays are relatively new and as such don't have a long track record on which to evaluate their ultimate longevity/durability, and that may be a concern to your dentist (especially in a case involving extreme bruxism). But it also has to be said that without question zirconia crowns are ever growing in popularity with dentists.

It could be that possibly your dentist isn't all that aware of this type of crown construction and the advantages it possibly offers, or are hesitant to change to something new.

In regard to those issues we'll mention that BruxZir is a trademark of Glidewell Laboratories. Possibly if you contacted them they could give you some leads as to whom in your area places a lot of these restorations and therefore has used them in your type of situation before and knows what type of outcome might be anticipated.

Good luck with this, wish we had more to offer.

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