Background: Esthetic restoration for primary anterior teeth constitutes one of the challenging situations in paediatric dental practice. Aim of the study: Assessment of the 12-month clinical performance of direct resin composite restorations of carious vital primary anterior teeth using custom 3D printed templates obtained from digitally waxed-up patients' dental models compared to conventional strip crowns. Subjects and methods: A single-center, prospective parallel arms randomized controlled clinical trial was performed in which 98 carious vital primary anterior teeth in 32 children were directly restored with resin composite either with the help of custom 3D printed templates (Group A: study group) or celluloid crown forms (Group B: control group). Restorations were assessed for surface luster, anatomical form, material fracture, marginal adaptation, and periodontal response using the revised FDI criteria on three occasions; a week after placement (T0), at six months (T1), and at twelve months (T2) of follow-up and the tooth was the unit of analysis. Chi-square/Fisher exact tests were used for comparisons between groups. Cohen's kappa statistic was used to test the assessors' reliability. A significant level was set when the p-value < 0.05. Results: Group A restorations showed better clinical performance for the tested criteria after 12 months, however, the results were not statistically significant except for the esthetic anatomical form (p= 0.03). Conclusion: Custom 3D-printed templates could be a superior alternative to traditional celluloid crown forms in the direct composite restoration of carious primary anterior teeth.