Study aim: This systematic review aimed to compare the clinical performance of cement-retained versus screw-retained single implant-supported crowns, and discuss implant survival, marginal bone loss (MBL), peri-implant soft tissue health, esthetic outcomes, and complication profiles. Materials and Methods: A systematic search was conducted in PubMed, Scopus, Web of Science, and Google Scholar for clinical studies published between 2018 and 2024. Eligible studies were randomized controlled trials, prospective, and retrospective cohort studies comparing cemented and screw-retained single implant crowns with a minimum follow-up of 6 months. Seven studies involving 396 patients and 464 implants met the inclusion criteria and were qualitatively synthesized. Results: Both retention types had high implant survival rates (98.8%–100%). No significant differences were observed in marginal bone loss or esthetic outcomes (PES/WES). Screw-retained restorations showed lower bleeding on probing (BOP%) in most studies, which indicate improved peri-implant soft tissue health, although one study reported a higher mucositis rate in this group. Mechanical complications, and screw loosening (1–8.7%), were more frequent in screw-retained crowns, while cement-retained restorations were associated with increased biological complications due to residual cement. Conclusion: Cement-retained and screw-retained implant crowns provide comparable survival and esthetic outcomes. Screw-retained restorations offer advantages in retrievability and soft tissue health but present higher mechanical complication risks. Cement-retained crowns is preferable in esthetically demanding situations in the anterior region. The choice of retention type is individualized based on clinical conditions, esthetic demands, and long-term maintenance considerations.