Purpose: The aim of this retrospective cohort study was to evaluate the clinical performance of zirconia-based implant-supported single crowns and fixed dental prostheses (FDPs) made by 15 members of the Italian Academy of Prosthetic Dentistry (AIOP) over a time period of up to 5 years. Materials and Methods: One hundred thirtyone patients were treated with a total of 210 zirconia-based single crowns and FDPs on implants in anterior and posterior regions. A cohort group with parafunctional habits was compared with patients without parafunctional habits according to the esthetic, functional, and biologic United States Public Health Service criteria modified by the FDI World Dental Federation. Results: The estimated cumulative survival (ECS) and standard error (SE) of all restorations on implants was 91.95% ± 1.39%, and the estimated cumulative success (ECSs) and SE was 88.37% ± 1.72%. The ECS of single crowns and FDPs was 91.25% ± 3.69% and 95.23% ± 2.28%, respectively, and the estimated cumulative success rates were 88.84% ± 2.05% and 87.96% ± 3.16%, respectively. Mechanical failures, including four zirconia core fractures, three hairline cracks, four chippings, and five delaminations of the ceramic veneering material, were recorded during a 1- to 5-year observation period. The odds ratio of 3.39 (95% confidence interval: 1.18 to 9.73) showed a moderate association between parafunction and failure. Conclusions: Zirconiabased implant-supported restorations showed encouraging clinical results over a period of up to 5 years, but more clinical data are needed before these restorations can be considered a viable treatment alternative. Mechanical failures were primarily observed in patients with parafunctions.