Objectives <p>To evaluate the 2-4-year clinical performance of lithium disilicate ceramic occlusal veneers for restoring vital cracked teeth and to explore factors associated with restoration failure.</p> Materials and methods <p>A prospective study was conducted on 60 cracked teeth from 51 patients. All restorations were evaluated according to the modified United States Public Health Service (USPHS) criteria: (a) marginal discoloration, (b) secondary caries, (c) restoration fracture, (d) adjacent contact point loosening, and (e) smoothness of adjacent areas. Risk factors were analyzed using χ² tests, Kaplan–Meier analysis, and univariate Cox proportional hazards regression.</p> Results <p>The restoration survival rate was 95% (57/60), and the restoration integrity rate was 85% (51/60). A total of 9 restorations met the broader failure definition used for exploratory risk-factor analysis, including 3 severe fractures requiring remaking and 6 marginal defects requiring repair. Among 60 occlusal veneers, none had severe discoloration or secondary caries. The worst scores for adjacent contact point loosening and surface smoothness were 5% (3/60) due to 3 restorations with severe fractures. Second molars showed a significantly higher risk of restoration failure compared with other teeth (χ² test: <i>p</i> = 0.024; Cox model: <i>p</i> = 0.024; Kaplan-Meier: <i>p</i> &lt; 0.01).</p> Conclusions <p>Occlusal veneers showed favorable medium-term restoration outcomes for restoring cracked teeth, with a high success rate observed over a 2-4-year follow-up period.</p> Clinical relevance <p>This study aims to help clinicians optimize the treatment planning of cracked teeth and improve the long-term success of occlusal veneer restorations.</p>