Aim: Esthetic dentistry is currently an essential component of dental practice. This study was conducted to compare the clinical performance of three types of crowns as esthetic alternatives to stainless steel crowns for primary molars. Materials and methods: Eighty lower second primary molars of children aged 4-8 years old were allocated into 4 groups: Group 1 (n = 20): received stainless steel crowns; group 2 (n = 20):  received the prefabricated commercially available zirconia crowns (NuSmile®); group 3 (n = 20):  received the locally manufactured zirconia crowns created via CAD/CAM system; and group 4 (n = 20): received the locally manufactured hybrid ceramic (Vita Enamic®) crowns created via CAD/CAM system. All crowns were cemented using resin modified glass ionomer cement. The Clinical Performance of four crowns in terms of gingival health (gingival index (GI) and plaque index (PI)), crown integrity and color stability were followed-up at 3, 6, 9 and 12 months. Results: There was a significant difference as zirconia crowns had better gingival health and color stability than stainless steel crowns and hybrid crowns. There was no significant difference between NZCs and CCZCs regarding gingival health, crown integrity and color stability. Conclusion: The SSCs had the best crown integrity while zirconia crowns had the best gingival health and color. The prefabricated CCZCs offers a new satisfactory cost effective esthetic option.