Preliminary Comparative Analysis of Monolithic Zirconia and Hybrid Metal–Ceramic Designs in Full-Arch Implant-Supported Restorations

Background: Material choice in full-arch implant-supported restorations significantly impacts longevity, complication rates, and patient satisfaction. This retrospective study compared monolithic zirconia versus hybrid metal–ceramic full-arch designs over a minimum three-year follow-up. Methods: Twenty patients (9 female, 11 male; mean age 55.4 ± 7.5 years) treated with full-arch implant-supported restorations were reviewed. Ten received monolithic zirconia restorations; ten received hybrid metal–ceramic. Clinical outcomes, including mechanical complications, prosthetic maintenance needs, opposing dentition wear, and patient-reported satisfaction (esthetics, comfort, masticatory function via VAS), were recorded. Statistical analyses were performed using Chi-square, independent t-tests, or Mann–Whitney U tests, with a significance level set at p < 0.05. Results: All implants (100%) and prostheses (>95%) survived. Monolithic zirconia exhibited no veneering chipping, while two events were observed in hybrid restorations (difference not statistically significant), and one bulk fracture occurred (monolithic). Hybrids had no framework fractures. Screw loosening occurred in one zirconia case. Mean VAS scores exceeded 9.0 in both groups; zirconia scored slightly higher for esthetics (9.4 ± 0.5 vs. 8.8 ± 0.6) and comfort (9.2 ± 0.6 vs. 9.0 ± 0.7). Polished zirconia resulted in no clinically detectable enamel wear, whereas hybrids with glaze loss caused occasional mild enamel wear but without functional impairment. Conclusions: Both restoration types show excellent survival and patient satisfaction over three years. Monolithic zirconia reduces veneering-related complications and maintenance, suggesting a possible advantage in functionally demanding cases with high occlusal loads or limited prosthetic space; hybrids may remain preferable when esthetic customization and gingival contour reproduction are paramount.