Introduction. Sjögren’s syndrome (SS) is a chronic autoimmune disorder characterized by lymphocytic infiltration of exocrine glands, leading to profound hyposalivation, xerostomia, and mucosal fragility. These pathophysiological changes pose significant challenges to prosthetic rehabilitation, including poor prosthesis retention, mucosal trauma, and increased susceptibility to infections.

Methods. We conducted a narrative review using PubMed, Scopus, and Web of Science, including clinical studies, systematic reviews, and case series (minimum 6-month follow-up), published in English between 2000 and 2024. Studies were selected based on their focus on prosthetic strategies—both tissue-supported and implant-supported—in SS patients. Exclusion criteria included animal studies and those not directly addressing prosthetic or pharmacological considerations.

Results:
Tissue-supported prostheses are often compromised by poor lubrication and mucosal ulceration, limiting their long-term use. In contrast, implant-supported prostheses, such as overdentures or fixed implant restorations, demonstrate superior performance in retention, patient comfort, and masticatory function. Digital technologies (e.g., CAD/CAM and 3D printing) improve adaptation and reduce surface roughness. Polished, low-porosity acrylic resins reduce microbial colonization, and bioactive coatings (antifungal, antimicrobial) are emerging as adjunctive options. However, current evidence is largely derived from case series and observational studies, underscoring the need for controlled trials.

Conclusions:
An integrated, multidisciplinary approach is essential. Besides careful prosthetic planning and biomaterial selection, pharmacological interventions (sialogogues, antifungals, remineralizing agents) are critical for managing xerostomia and its consequences. Long-term follow-up protocols, including periodic relining, hygiene reinforcement, and management of peri-implant health, are crucial for implant longevity. Future research should explore implant survival rates in SS, biomaterial innovations with mucosa-friendly interfaces, and personalized protocols for maintenance and oral microbiome modulation. Prosthetic success in SS hinges on precision, prevention, and collaboration.