Recommendations for all-ceramic implant-supported single crowns are partly based on the 6th Consensus Conference of the European Association of Osseointegration (EAO) [3]. The data pool comprises 2,045 restorations from 52 studies included in a systematic review [4] and additional up to date author searches [5,6,7,8]. Table 1 provides an overview of the recommendations outlined in Part A.

Lithium disilicate, (leucite-reinforced) silicate, or zirconia ceramics demonstrate favorable survival rates (96–97% at 3 years) and are recommended for implant-supported single crowns. The recommendation for zirconia is not limited to specific generations. One clinical study successfully evaluated 6Y-PSZ zirconia crowns (6 mol% yttria—partly-stabilized zirconia, ~ 600 MPa flexural strength) over 2 years [7]. By contrast, second-generation tooth-colored opaque zirconia typically shows ~ 1200 MPa flexural strength, with excellent long-term data.

Implant-supported single crowns made of resin nano-ceramic, also referred to as PICN (polymer-infiltrated ceramic network) show variable but consistently lower survival rates, which report as low as 14% after one year [9], and should therefore not be used.

Based on available evidence, the guideline allows flexibility in the extend of veneering implant-supported single crowns. However, monolithic or micro-veneered designs are strongly preferred over fully veneered crowns due to a reduced risk of ceramic chipping. Micro-veneering involves a 0.5 mm layer in non-functional areas. Another recommendation highlights the importance of knowledge about material properties and proper application of intra- and extraoral bonding protocols by both clinicians and dental technicians. For all-ceramic restorations, knowledge and adherence to protocols is critical for success.

The systematic literature review identified nine clinical studies with a total of 330 short-span implant-supported fixed dental prostheses (i-FDPs) [8, 10,11,12,13,14,15,16,17]. Only zirconia was found suitable and should exclusively be used in this indication. Sufficient data exists only for second-generation 3Y-TZP zirconia with > 1000 MPa flexural strength. There is no clinical data for newer generations or material combinations. An overview of the recommendations from Part B is presented in Table 2.

Thus, a separate recommendation addresses the wide variability of zirconia generations. Patient education regarding the limited data for newer zirconia types (e.g., multilayers) is essential. No general superiority was found for cemented versus screw-retained short-span i-FDPs. Cementation should be performed on customized abutments to allow better control of excess material. Screw-retention should utilize titanium bases with sufficient height and parallel retention surfaces.

As with crowns, micro-veneering reduces chipping risk in short-span i-FDPs. In posterior regions, monolithic or micro-veneered designs are preferred. Some promising clinical data exist for cantilevered all-ceramic i-FDPs, but patient education about limited evidence is necessary [18,19,20].

The body of evidence for full-arch implant-supported all-ceramic restorations stems from the authors’ systematic literature search. It remains limited, with only 202 restorations reported across three clinical studies [21,22,23]. Clinical data is available exclusively for 3Y-TZP zirconia, which is therefore the only material currently recommended. Table 3 summarizes the recommendations derived from Part C.

Because of the scarcity of data and short observation periods, no recommendation is made regarding veneering design. High complication rates have been reported. Therefore, a strong recommendation is made for thorough patient education when using an all-ceramic full-arch restoration. Given the complication risks, restorations should allow removability and reinsertion, using screw-retained connections via titanium bases or multi-unit abutments. Additionally, protective splints are recommended to prevent complications.

Overall, metal-ceramic restorations remain the gold standard in this indication due to the limited evidence for all-ceramic alternatives.

Part D presents overarching recommendations for all-ceramic implant-supported restorations. In cases of diagnosed or suspected bruxism, patients should be informed about the increased risk of complications, the need for a nocturnal protective splint, and possible manufacturer-imposed indication limits. All-ceramic restorations adjusted intraorally should be polished to high gloss to ensure surface integrity. Clinicians should consider material-specific biomechanical risks and perform regular occlusal checks, especially for monolithic zirconia, to avoid overloading the implant–abutment connection. Given the wide range of ceramic materials and compositions, particularly varying zirconia generations, material selection should be coordinated between clinician and dental technician.