Comparison of Clinical Outcomes and Parental Satisfaction Between Zirconia and Composite Strip Crowns in Children With Decayed Primary Incisors: A Systematic Review and Meta-Analysis

Background: Zirconia and composite strip crowns are considered as restorative options for decayed primary incisors in children. Zirconia crowns are preferred for their durability and natural appearance, while composite strip crowns are valued for their cost-effectiveness and ease of use. However, differences in their long-term clinical outcomes and parental satisfaction remain a key consideration in paediatric dentistry. Aim: The aim of this systematic review and meta-analysis was to compare the effectiveness and evaluate long term outcomes of zirconia and composite strip crowns for restoring primary incisors. Materials and Methods: The data were explored through advanced searches and databases for articles published between 2013 and 2026 to identify studies investigating the long-term outcomes of zirconia and composite strip crowns for restoring primary incisors. Results: Eight randomized controlled trials and one non-randomized prospective study were included. Zirconia crowns demonstrated significantly better gingival health, lower plaque accumulation, higher crown retention, reduced restoration failure, and superior color stability compared with composite strip crowns at ≥12 months. Meta-analysis showed significantly higher odds of crown retention (OR 7.549), lower restoration failure (OR 0.158), and improved gingival outcomes for zirconia crowns. However, zirconia crowns were associated with significantly higher odds of opposing tooth wear (OR 6.640). Parental satisfaction tended to favor zirconia crowns, though the pooled estimate showed wide uncertainty. Conclusion: The observed clinical acceptability of all crowns used to treat primary anterior teeth at the 12 months mark indicates that both zirconia crowns and composite strip crowns can perform adequately in practical applications. Parental reports suggest higher satisfaction with preformed primary anterior zirconia crowns compared to strip crown. Across several outcomes, zirconia crowns generally demonstrated favorable trends, including clinical retention, lower plaque and gingival index values, enhanced color match, and lower rates of restoration failure; however, some measures were comparable between the two crown types, and pooled estimates for certain outcomes were not statistically significant or were imprecise.