What do you put in your stearer to tighten your stem, or do you you use less torque now that it doesn't hold the preset?
If the steerer is of the alloy/carbon type you can use a starnut and topcap + screw to set the load on the bearing cups.
Once you've done that and the stem is alligned and it's bolts torqued properly there's no need to keep the starnut, tightening bolt and topcap in place although I'd leave the starnut as is.
So the bolt and topcap can go, you replace the topcap with a lightweight one with no hole in it that you can pressfit into the top of the steerer tube or use something like the USE affair which still allows for some fine adjustments from what I understand.
If the steerer is of the full carbon type, a compression device is used that sets itself firmly against the sidewall of the steerer by means of expansion against which the load on the bearings is set in a similar way as the starnut/bolt/topcap combo used for the alloy/carbon types.
Anything after that remains the same as described above.
So, in essence, after the preload on the bearings is set by either one of these systems it is the stem's tightened down bolts and, if any, the spacers underneath that keep it in place and loaded down evenly.
You'll only need to redo the whole ritual should you want to change the fork, regrease the headset bearings or should you want to replace the headset itself for instance.