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Aim: To evaluate the clinical performance of lithium disilicate crowns restoring endodontically treated teeth with two occlusal preparation schemes. Materials and methods: Forty full coverage lithium disilicate restorations were fabricated for posterior endodontically treated teeth. Patients were divided into two groups according to the preparation design, Group PO (control group): Planar occlusal design and Group FO (intervention group): Flat occlusal design. The preparation was standardized with deep chamfer finish line for all teeth. The restorations were milled from e.max CAD blocks and proper adhesive protocol was followed. After final cementation, the clinical performance of the restorations was evaluated according to the USPHS criteria in terms of fracture, marginal adaptation, marginal discoloration and secondary caries. These measurements were recorded at baseline, after 3, 6, 9 and 12 months respectively. Results: No statistically significant difference was detected between both groups for all tested outcomes (Fracture, marginal adaptation, secondary caries and marginal discoloration) over one year. While comparison between follow-up periods revealed statistically significant difference within the PO group, regarding marginal discoloration (P ≤ 0.05). Conclusions: Both planar and flat occlusal design revealed successful clinical performance with lithium disilicate full coverage restorations.