Abstract
BACKGROUND: Prefabricated zirconia crowns (PZCs) and resin-bonded composite strip crowns (RCSCs) represent the principal restorative approaches to handle caries in anterior primary teeth. However, the comparative effectiveness of these two materials remains inconclusive. This research aimed to systematically evaluate and compare the effectiveness of PZC and RCSC in the restoration of pediatric primary anterior teeth. METHODS: A search was implemented across multiple databases, encompassing Web of Science, PubMed, Embase, and The Cochrane Library. The search duration was from database inception to June 21, 2025. The Cochrane Risk of Bias Tool (RoB 2.0) was implemented to estimate the RoB in the eligible articles. The therapeutic effectiveness and adverse effects of PZC and RCSC were estimated by computing risk ratios (RR) and their corresponding 95% confidence intervals (CIs). Statistical analysis was implemented utilizing Stata 16 software. RESULTS: In total, 2725 articles were identified. Nine studies that involved 1746 primary anterior teeth from children aged 3–6 years were included. The incidence of secondary caries was considerably diminished in the PZC cohort relative to the control cohort (RR = 0.41, 95% CI: 0.18–0.92, p = 0.030). Wear of the opposing teeth was significantly greater in the PZC cohort relative to the RCSC cohort (RR = 7.58, 95% CI: 2.73–21.07, p < 0.001). The retention rate of the PZC cohort was notably higher than that of the RCSC cohort (RR = 0.15, 95% CI: 0.07–0.33, p < 0.001). No considerable distinctions were detected in color mismatch between the two cohorts (RR = 0.24, 95% CI: 0.05–1.21, p = 0.084). The incidence of restoration failure was considerably diminished in the PZC cohort (RR = 0.07, 95% CI: 0.02–0.22, p < 0.001). The likelihood of gingival bleeding displayed no statistically significant distinction between the two cohorts (RR = 0.09, 95% CI: 0.01–1.73, p = 0.109). Plaque formation was considerably less frequent in the PZC cohort (RR = 0.08, 95% CI: 0.01–0.23, p < 0.001). The marginal fit was considerably superior in the PZC cohort (RR = 0.50, 95% CI: 0.05–8.70, p = 0.672). CONCLUSION: PZCs demonstrated superior performance in terms of secondary caries prevention, crown retention, success rates of restoration, marginal fit, and plaque accumulation. In contrast, RCSCs exhibited significantly less wear of opposing teeth. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1186/s12903-026-07759-z.