Purpose: The objectives of this work were to systematically review the effect of bruxism on the survival of zirconia restorations on teeth and to assess the prevalence of nocturnal masseter muscle activity in a clinical sample. Materials and Methods: A Medline search was performed independently and in triplicate using the term "zirconia" and activating the filter "clinical trial." Furthermore, three other electronic databases were searched using the same term. Only papers published in English on prospective studies of veneered zirconia frameworks on teeth were included. To estimate the prevalence of sleep bruxism in clinical settings, subjects with no clinical signs of bruxism and who did not report grinding and/or clenching were examined by use of a disposable electromyographic device. Results: The initial search resulted in 107 papers, of which 22 were included in the analysis. Bruxers were excluded in 20 of these articles. In 1 study bruxers were not excluded, and 1 study did not provide information regarding this issue. The methods used to identify bruxers were heterogeneous/not described, and no study used reliable, valid methods. Of 33 subjects without clinical signs of bruxism, nocturnal muscle activity exceeded predefined muscle activity for 63.8% of the subjects. Conclusion: There is a lack of information about the effect of bruxism on the incidence of technical failure of veneered zirconia restorations because all available studies failed to use suitable instruments for diagnosis of bruxism. Nocturnal muscle activity without clinical symptoms/report of bruxism was observed for a relevant number of patients. Int J Prosthodont 2014;37:127-133. doi: 10.11607/ijp.3652