Although zirconia implants (ZIs) have demonstrated favorable outcomes for single crowns in low-load regions, their performance in more demanding prosthetic scenarios such as supporting fixed partial dentures (FPDs) and complete arch prostheses remains unclear.

The purpose of this systematic review (SR) and meta-analysis was to assess the clinical outcomes of ZIs supporting 3-unit FPDs or complete dentures (fixed or removable), including survival and success rates, marginal bone loss (MBL), and reported complications.

This SR followed the preferred reporting items for systematic reviews and meta-analyses (PRISMA) guidelines and was registered in the international database to register systematic reviews (INPLASY). A comprehensive literature search across 5 databases and nonpeer-reviewed literature was conducted until February 2025. Studies reporting on ZIs used to support FPDs (≥3 units) or complete arch prostheses were included. Risk of bias was assessed using the RoB2 or ROBINS-I tools. A meta-analysis was conducted for survival rates, and prediction intervals were calculated to determine outcome variability.

Thirteen studies with 737 ZIs and 501 participants were included. The pooled survival rate for ZIs supporting FPDs was 93.2% (mean follow-up: 44.9 months), while for overdentures, it was 69.5% (mean follow-up: 12 months). The prediction intervals suggested high heterogeneity and outcome variability. The overall success rate was 90.2%, and the mean MBL was 1.23 mm, with no significant correlation to follow-up time. The main mechanical complication was prosthetic fracture, while biological complications involved MBL and peri-implantitis.

The ZIs supporting 3-unit fixed dental prostheses demonstrate favorable survival and success rates in short- and mid-term follow-ups, supporting their use in esthetically demanding, low-load clinical situations. However, their performance in overdenture applications appears less predictable, with significantly lower survival rates and broader variability in outcomes.