Bruxism is commonly considered a detrimental motor activity, potentially causing overload of the stomatognathic structures and representing a risk factor for dental implant survival. The available literature does not provide evidence-based guidelines for the management of bruxers undergoing implant-retained restorations. The present paper reviewed current concepts on bruxism etiology, diagnosis and management, underlining its effects on dental implants in an attempt to provide clinically useful suggestions based on scientifically sound data. Unfortunately, very little data exists on the subject of a cause-and-effect relationship between bruxism and implant failure, to the point that expert opinions and cautionary approaches are still considered the best available sources for suggesting good practice indicators. By including experimental literature data on the effects of different types of occlusal loading on peri-implant marginal bone loss along with data from studies investigating the intensity of the forces transmitted to the bone itself during tooth-clenching and tooth-grinding activities, the authors were able to compile the suggestions presented here for prosthetic implant rehabilitations in patients with bruxism.