PurposeThe aim of this systematic review was to assess enamel wear on teeth opposing zirconia restorations and to evaluate factors related to the wear of natural teeth opposing zirconia restorations. Materials and MethodsFive electronic databases were searched through May 2013 without limitations. The terms antagonist*, enamel, wear, and zirconi* were used. Titles and abstracts were initially screened, and those that fulfilled the inclusion criteria were selected for a full-text assessment. Studies that evaluated only the material wear were not included. ResultsThe database search strategy retrieved 142 potentially eligible studies. After the duplicate studies were removed, 62 studies were obtained. Titles and abstracts that fulfilled the inclusion criteria were selected for a full-text assessment (25). Seven laboratory studies met the inclusion criteria. In addition, reference lists from the finally selected studies were also screened. ConclusionsThere was a large variation in relation to wear test method quantification, applied force, lateral movement, number and frequency of cycles, number of specimens, and enamel specimen preparation. In all studies, enamel wear rates were lower against polished zirconia. Differences in the test methods did not allow for comparisons of wear rates among the studies. Clinical Significance: Polishing the surface is recommended for a full-contour zirconia restoration because polished zirconia presents favorable wear behavior opposing natural teeth.