Aim of study: To evaluate the clinical performance of preveenered and Zirconia crowns in comparison to stainless steel crowns. Materials and Methods:Twenty four children were classified randomly into two groups (n=12) according to the type of the esthetic crown used (preveneered crown (G.I) or zirconia crown (G.II)) and a matched pair study design was performed.Pulpotomy was performed for each lower first primary molar and then one tooth was covered by stainless steel crown(SSC) on one side while the other side received an esthetic crown (zirconia (ZR) or preveneered (PVSSC) ). Follow up was at postoperative time, then after 1 week, 1, 3, 6, 9, 12 months and radiographs were taken postoperatively and after 12 months. Results: SSCsscoredthe highest rates of retention followed by zirconia and finally preveneered crowns.Zirconia crowns had very high color stability through the 12 months of follow up, while PVSSCs changed color with bad oral hygiene.SSCs and ZR crowns showed excellent gingival health, although PVSSCs showed some sort of inflamation. All esthetic crowns had more than 1 mm marginal extension subgingivally, while margins of SSCs extended in a range between 0.5 to 1 mm which was highly significant(≤0.001). Most of the crowns occluded properly and had an intact contact. No bone resorbtion was noted. Conclusion: zirconia crowns showed excellent gingival health integrity, while PVSSCs had poorer gingival health, was bulky and changed color with bad oral hygiene. SSC still an acceptable option for full coverage of posterior primary teeth and ZR crown can be considered a viable esthetic alternative.