AbstractObjectivesThe objective of this study is to compare monolithic hybrid abutment crowns (screw‐retained) versus monolithic hybrid abutments with adhesively cemented monolithic single‐tooth crowns.Materials and MethodsTwenty subjects in need of an implant‐borne restoration were randomly assigned to receive either a cement‐retained (CRR) or a screw‐retained (SRR) implant‐supported monolithic lithium disilicate (LS2) reconstruction. Each patient received a titanium implant with in internal conic connection. After osseointegration and second‐stage surgery, healing abutments were placed for about 10 days. The type of restoration (CRR vs. SRR) was randomly assigned, and the restorations were manufactured of monolithic LS2. Both types of restorations, CRR and SRR, were based on a titanium component (Ti‐base) that was bonded to the abutment (CRR) or the crown (SRR). The follow‐up period for all restoration was 36 months. Clinical outcome was evaluated according to Functional Implant Prosthetic Score (FIPS). Quality of live (OHIP) and patient's satisfaction were assessed using patient‐reported outcome measures (PROMs). Primary endpoint was loss of restoration for any reason. Kaplan–Meier curves were constructed and log‐rank testing was performed (p < .05).ResultsOne restoration of group CRR failed after 6 months due to loss of adhesion between Ti‐base and individual abutment. No further biological or technical failures occurred. Kaplan–Meier analysis showed no significant difference between both treatment options (p = .317). There was no statistically significant difference between both types of restoration, neither for FIPS, OHIP, treatment time nor patient satisfaction (p > .05).ConclusionMonolithic hybrid abutment crowns (screw‐retained) and monolithic hybrid abutment with adhesively cemented monolithic crowns using lithium disilicate showed no statistically significant difference for implant‐based reconstructions in this pilot RCT setting.