Purpose: To compare the clinical outcomes of screw-retained vs cemented single crowns supported by customized zirconia abutments on implants. Materials and Methods: Thirtytwo patients received implant-supported (Regular Neck, Tissue-Level, Straumann AG), single-tooth restorations with customized zirconia abutments in the anterior areas. Participants were randomly assigned to the screw-retained (full-crown abutment [FCA]) group or the cemented (zirconia crown [ZrC]) group and followed up over a 10-year period. Prosthetic and biologic complications, marginal bone level (MBL), mucosal recession, and pink and white esthetic scores (PES and WES, respectively) were evaluated. Results and Conclusion: There were no implant failures during the study period; after 10 years, 94% of crowns were functional. Prosthetic complications were recorded in both groups (three FCA and two ZrC), and no significant difference was found (P = .65). Two cases of mucositis were recorded, one in each group. Esthetic outcomes were assessed using PES and WES scores. MBL was 0.95 mm in the ZrC group and 0.82 mm in the FCA group, with no significant difference between groups. These encouraging preliminary results need to be confirmed with long-term follow-up on larger study samples.