Occlusion in Implant-Supported Fixed Partial Restorations: Biological Basis, Biomechanical Considerations and Clinical Recommendations

Background/Objectives: The management of occlusion in implant-supported fixed partial restorations (ISFPRs) remains a controversial topic because of the limited availa-bility of high-level clinical evidence and the biomechanical differences between natural teeth and dental implants. The absence of the periodontal ligament and the altered biomechanics of implants have led to specific occlusal concepts. This narrative review provides an up-to-date overview of the biological basis of implant occlusion, the role of occlusal overload, occlusal concepts, prosthetic materials, and long-term maintenance strategies for ISFPRs. Methods: A narrative review was conducted through an electronic search of the PubMed/MEDLINE database covering the period from 1 March 2001 to 1 March 2026. Clinical studies, review articles, in vitro studies, and finite element analyses addressing occlusal management in ISFPRs were selected and synthesized according to their clinical relevance. Results: The available literature indicates that evidence sup-porting specific occlusal protocols for ISFPRs remains limited and heterogeneous. Con-temporary occlusal concepts emphasize minimizing non-axial loading, optimizing oc-clusal morphology, controlling cantilever extension, and considering patient-specific factors such as bruxism. Monolithic zirconia represents one of the most suitable restor-ative options because of its favorable mechanical performance and reduced technical complications. Long-term maintenance and periodic occlusal reassessment remain es-sential, as occlusal relationships continue to change throughout life. Conclusions: Alt-hough numerous occlusal concepts have been proposed, high-level evidence remains limited, highlighting the need for future prospective studies aimed at establishing evi-dence-based occlusal protocols for ISFPRs. Clinicians should adopt individualized oc-clusal strategies guided by sound biomechanical principles while acknowledging the current limitations of the available evidence.