Implant-supported fixed restorations have become a widely accepted treatment modality in contemporary prosthodontics, offering functional and esthetic solutions for partially and fully edentulous patients. Two main retention methods—screw-retained and cement-retained restorations—are commonly used, each presenting specific clinical advantages and limitations. Screw-retained prostheses allow retrievability and reduce the risk of peri-implant inflammation due to excess cement, while cement-retained options often offer superior esthetics and occlusal control. The choice between these techniques depends on various factors including implant angulation, interocclusal space, esthetic demands, and maintenance considerations. This text provides a comparative overview of both systems, highlights indications and contraindications, and discusses current materials, design principles, and long-term outcomes based on clinical experience and literature.