PURPOSE The aim of this study was to test whether posterior zirconia-ceramic (ZC) and metal-ceramic (MC) fixed dental prostheses (FDPs) exhibit similar survival and technical/biologic complication rates. MATERIALS AND METHODS A total of 58 patients in need of 76 posterior FDPs were randomly assigned to receive 40 ZC and 36 MC FDPs. The restorations were examined at baseline (cementation) and yearly for 5 years. Technical and biologic outcomes were compared. The independent treatment groups were compared with nonparametric Mann-Whitney test for metric variables and with Fisher exact test for categoric data. RESULTS A total of 52 patients with 40 ZC and 29 MC FDPs were examined at 5 years. No FDP failed during the 5 years; 2 ZC FDPs failed at 65.4 and 73.3 months. Debonding occurred at 3 ZC FDPs. Technical outcomes (modified US Public Health Service criteria) and general periodontal parameters did not show significant differences between ZC and MC FDPs. CONCLUSION ZC FDPs exhibited similar outcomes to MC FDPs based on 5-year survival estimates. The majority of technical and biologic outcome measures were not significantly different.