Background: The necessity for good aesthetics, strength, and longevity make the providing restorations to children's anterior teeth a difficult undertaking. The Prefabricated primary anterior zirconia crowns and resin composite strip crowns on primary maxillary central and lateral incisors were compared in this study with regard to gingival health, restoration failure, and the opposing tooth wear over intervals of 3, 6, and 9 months. Methods: Children who need restorations and were enrolled in the Department of Pediatric and Preventive Dentistry at the Govt. College of Dentistry Indore, MP, India, were screened for the eligibility. 116 teeth were treated in total; 59 were given the preformed primary anterior zirconia crowns and 57 were given strip crowns. Utilizing IBM's SPSS software 21.0 edition, basic random allocation was used for the randomization. Chi-square test was used to compare the categorical variables. P value.05 and the higher value were regarded as statistically significant. The research that was presented was retroactively registered at the Clinical Trials on 20th March, 2021, with registration number IEC/SS/21 Results: The Zirconia crowns demonstrated considerably decreased gingival bleeding at the 3, 6, 9-month follow-up intervals (p value <.05), no restoration failure (p value <.05), and no discernible difference between the two crowns in terms of wear on the opposing teeth. Conclusion: According to our research, teeth with the zirconia crowns over time exhibit superior gingival health and fewer restoration failure. However, neither a zirconia crown nor a strip crown causes any opposing tooth wear.