Achieving functionally and esthetically pleasing rehabilitation of edentulous patients is a key goal in implant dentistry [1]. However, successful implant treatment depends on bone quantity and quality [2,3], surrounding soft tissues [4], implant positioning [5], and prosthesis design [1,6,7], making full-arch rehabilitation a challenging process that requires thorough clinical planning.

The digital workflow is becoming increasingly popular due to considerable technological advancements, offering clinical convenience, favorable patient experiences, and cost- and time-effectiveness [8,9]. Despite these advantages, full-arch digital rehabilitation remains technically demanding, particularly during intraoral scanning, where mobile mucosa and the lack of anatomical landmarks may compromise scan accuracy [8]. While recent studies report promising results with titanium and zirconia frameworks [[10], [11], [12], [13]], further clinical validation is still needed [14].

Hybrid full-arch implant-supported fixed dental prostheses (FDPs), consisting of a zirconia or metal framework veneered with acrylic resin or porcelain, are well-documented and widely used in clinical practice [1,15]. However, chipping and fracture of veneered porcelain remain a significant concern with multilayered FDPs [6]. Additionally, the ceramic layer, when combined with a metal or zirconia framework, requires sufficient prosthetic space to ensure optimal material thickness [15]. Monolithic zirconia FDPs overcome these limitations by providing full-contour frameworks with enhanced structural integrity and reduced fracture risk [1,6,7]. Highly polished zirconia also minimizes bacterial adhesion [16], and CAD/CAM technology allows efficient fabrication and replacement of FDPs [1].

Although several in vitro studies have evaluated the durability of digitally fabricated monolithic zirconia full-arch FDPs [6,7,10,12,13], clinical data remain limited. This approach has been mainly described in clinical case reports [[17], [18], [19], [20], [21], [22], [23]], one pilot clinical trial [11], and a retrospective study [24]. To date, no clinical study has investigated this workflow prospectively, making the present study the first of its kind.

Therefore, the primary aim of this prospective cohort study was to evaluate the success and survival rates of full-arch implant-supported monolithic zirconia FDPs over 2 years of follow-up. The secondary aim was to identify potential risk factors associated with bone loss around implants. The first null hypothesis was that full-arch implant-supported monolithic zirconia FDPs would exhibit no significant implant or FDP failures and would maintain their clinical success and survival over the 2-year follow-up period. The second null hypothesis stated that no specific clinical, anatomical, or prosthetic risk factors would have a significant effect on marginal bone level (MBL) changes over time.