Children's anterior teeth restorations present a difficult challenge since they require high standards of strength, longevity, aesthetics, and less restoration microleakage. This study was performed on primary maxillary anterior teeth, comparing prefabricated aesthetically pleasing and cost-effective CAD/CAM Polymethyl Methacrylate crowns (PMMA) and resin composite strips. Materials and methods: A total of 60 teeth anterior maxillary were treated in 22 children aged 3-5.5. Group-I included 30 primary anterior teeth covered by PMMA crowns while group-II included 30 primary anterior teeth covered by strip crowns. Crowns were assessed regarding color match crown contour, gingival and plaque indices, restoration failure, and marginal integrity over three, six, and nine months. Results: PMMA crowns showed a significantly good color match with adjacent teeth at 6, and 9-month follow-up periods (p=0.0102, and 0.0016, respectively) also, significantly adequate marginal integrity was observed at 6, and 9-month followup periods (p=0.0837, 0.0700, respectively). There were losses of 3 lateral incisors and 1 more lateral incisor at 6 and 9 months respectively in the PMMA group. Moreover, less gingival bleeding, and less plaque accumulation at the 6- and 9-month follow-up visits in the PMMA group. Conclusion: It was concluded that teeth covered with prefabricated CAD/CAM-PMMA crowns exhibit improved gingival health, marginal integrity, crown shape, color match, and decreased bleeding, plaque accumulation, and material loss over time. CAD/CAM Polymethyl Methacrylate crowns (PMMA) could be used as a cost-effective aesthetic crown restoration for anterior primary teeth.