Purpose: The aim of this systematic review was to evaluate the long-term clinical performance of one-piece implants. Materials and Methods: An electronic MEDLINE search complemented by a manual search was conducted to identify randomized and prospective cohort studies on one-piece implants. Additional inclusion criteria were: a mean follow-up period of at least 5 years and an inception cohort where more than 80% of the enrolled patients remained in the study at the 5- or 10-year observation point. Results: Sixty-six studies from an initial yield of 597 titles were selected, and the data were extracted. Of the full-text articles examined, 46 were excluded from the final analysis. A total of 20 articles were finally selected. All studies were published between 1995 and 2011. Two different study designs were included: 4 randomized controlled trials and 16 prospective cohort studies. The studies were analyzed and classified according to the follow-up period, the type of implant surface, the type of edentulism, the type of loading protocol, and the type of setting. The meta-analysis of the included studies showed an implant survival rate for one-piece, one-part implants of 96.79% (95% CI: 94.04% to 98.71%) after 5 years. In one-piece, two-part implants, the survival rate was slightly higher: 98.16% (95% CI: 96.48% to 99.31%) after 5 years and 96.83% (95% CI: 93.12% to 99.24%) after 10 years. Conclusion: Within the limits of this systematic review, it can be concluded that high longterm survival rates can be observed with one-piece implants. Further randomized clinical trials are needed to provide more information about the outcome of different variables associated with one-piece implants.