Background <p>Bruxism represents a significant risk factor for complications in implant-supported rehabilitations. Unlike natural teeth cushioned by periodontal ligament, the rigid osseointegrated connection transmits excessive bruxing forces directly to the implant-bone interface and prosthetic components.</p> Objective <p>This narrative review synthesizes current knowledge regarding bruxism-related complications in implant-supported rehabilitations and evaluates available management strategies.</p> Methods <p>A comprehensive narrative review was conducted using PubMed/MEDLINE, Embase, Web of Science, Scopus, Cochrane Library, and Science Direct databases covering publications from January 1990 to December 2024. Studies investigating bruxism’s relationship with dental implant outcomes, clinical complications, and management strategies were included.</p> Results <p>Systematic reviews demonstrate that bruxing patients have 2.2–4.7 fold increased implant failure risk compared to non-bruxing patients. Finite element analyses reveal that occlusal splints reduce stress concentration by 33–73% depending on load magnitude. Limited evidence exists regarding the association between bruxism and peri-implant bone loss. Technical complications include prosthetic component fractures, screw loosening, and framework failures. Management strategies include occlusal splint therapy, modified prosthetic designs, strategic implant placement, and comprehensive follow-up protocols.</p> Conclusions <p>While bruxism significantly increases the risk of complications in implant-supported rehabilitations, successful outcomes are achievable through comprehensive management approaches. Evidence supports the effectiveness of occlusal splints in stress reduction and splinted prosthetic designs for optimal force distribution. However, the relationship between bruxism and implant complications remains complex, requiring standardized diagnostic criteria and evidence-based treatment protocols.</p>