The aim of the study is to compare the prosthetic maintenance requirements between implant-retained ball overdentures versus fixed screw-retained implant prosthesis. Clinical and radiographic changes in peri-implant tissue with using PGE2 as a peri-implant crevicular fluid (PICF) biomarker were also evaluated. 54 completely edentulous patients were enrolled: group I, 27 patients were rehabilitated with fixed screw retained restorations; group II, 27 patients with ball retained implant overdenture. Prosthodontic complications were calculated. The clinical parameters were recorded and PICF was collected at baseline, 6- and 12-months postoperatively. There was no statistically significance difference between group I and group II regarding the frequency of maintenance of prosthetic parts of both types of restorations. There was a statistically significance difference between group I and group II regarding the frequency of maintenance of implant components. At 6‐ and 12‐month observation periods, group I showed statistically significant lower mean plaque index, gingival index, and pocket depth compared with group II (P < .001). There was a statistically significant higher peri-implant marginal bone loss for group II compared with group I. There was no statistically significant difference in PGE2‐PICF levels between the two groups (P > .05). There was no difference in the frequency of maintenance of prosthetic parts between fixed screw retained restorations and ball retained over denture while the fixed screw retained restorations showed lower rate of maintenance of implant components. The screw retained group was more vulnerable than the ball group with respect to maintaining peri-implant tissue health.