Objectives To compare the survival and complication rates of posterior screw‐retained monolithic lithium disilicate (LS2)/veneered zirconia (ZrO2) single implant crowns (SICs), as well as analyze the occlusal changes observed during a 3‐year follow‐up period. Materials and Methods Thirty‐three patients were included and randomly divided into two groups. The test group consisted of 17 patients who received monolithic‐LS2–SIC, while the control group consisted of 16 patients who received veneered‐ZrO2‐SIC. Implant/prosthesis survival rates, technical complications, peri‐implant soft tissue conditions, and quantitative occlusal changes of SIC (obtained by the intra‐oral scanner and analyzed in reverse software Geomagic Control 2015) were assessed at 1‐ and 3‐year follow‐ups. Bone loss and Functional Implant Prosthodontic Score (FIPS) were evaluated at a 3‐year follow‐up. Results After a 3‐year follow‐up period, one patient dropped out of the follow‐up. No implant loss was observed. One crown was fractured, resulting in prosthesis survival rates of 93.75% for the monolithic group and 100% for the veneered group. A technical complication rate of 25% (4/16) was observed in the veneered group (p = .333). No significant differences in the marginal bone loss were observed at the 3‐year follow‐up (0.00 (−0.22, 0.17) mm versus 0.00 (−0.12, 0.12) mm, p = .956). The total FIPS scores for the test group were 9.0 (9.0, 9.0), while the control group received scores of 9.0 (8.0, 10.0) (p = .953). The changes in mean occlusal clearance were 0.022 ± 0.083 mm for the test and 0.034 ± 0.077 mm for the control group (at 3 years, p = .497). The changes in occlusal contact area were 1.075 ± 2.575 mm2 for the test and 1.676 ± 2.551 mm2 for the control group (at 3 years, p = .873). Conclusion After a 3‐year follow‐up, screw‐retained monolithic LS2 and veneered ZrO2 SIC demonstrated similar survival rates. The occlusal performance of implant prostheses needs to be closely examined during follow‐up, and appropriate occlusal adjustments need to be considered.