Preformed metal crowns (PMCs) have been the restoration of choice for paediatric dentistry; however, PMCs have a non-aesthetic appearance, which has become a point of concern. Recently, prefabricated zirconia crowns (PZCs) have been increasingly used as an aesthetic restorative material for primary teeth, as they have pleasing properties. This systematic review summarises the clinical results for PZCs in the primary dentition, including wear on the opposing dentition, retention, fracture resistance, parental satisfaction, gingival health, and cementation materials. Electronic database searches were conducted using PubMed, Google Scholar, Web of Science, and the Cochrane Library. Clinical trials, observational studies, and case reports/series were included. The quality of the studies was analysed using the Cochrane tool and the domain-based evaluation for non-randomised studies of interventions. The search retrieved 166 references, of which 14 studies were included for qualitative analyses. The risk of bias varied from low to unclear. The included studies indicated that prefabricated zirconia crowns are retentive and are not associated with accelerated wear on the opposing dentition. They also exhibit a high fracture resistance, satisfy the parents and are compatible with gingival health. There is, however, inconclusive evidence with regard to cementation materials. Prefabricated Zirconia Crowns appear to be a good alternative to preformed metal crowns in term of esthetics, retention, resistance to fracture, parent satisfaction, and gingival health.