Background The permanent tooth formation process may be disrupted in preterm infants with potential discrepancies in size and subsequent occlusal disturbances. Objective To systematically analyse and quantitively synthesize the available evidence regarding the impact of preterm birth on permanent tooth crown dimensions. Search methods Unrestricted searches in 6 databases and manual searching of the reference lists in relevant studies were performed up to March 2021 (Medline via PubMed, CENTRAL, Cochrane Database of Systematic Reviews, Scopus, Web of Science, ProQuest Dissertations and Theses Global). Selection criteria Observational studies investigating permanent tooth crown dimensions in preterm and control full-term born individuals. Data collection and analysis Following study retrieval and selection, relevant data were extracted, and the Newcastle-Ottawa scale was used to assess the selection, comparability, and outcome domains. Exploratory synthesis and meta-regression were carried out using the random effects model. Results Three studies were located from the initially retrieved records and the assessments with the Newcastle-Ottawa scale identified issues regarding the selection and comparability domains. Overall, the mesiodistal and the buccolingual dimensions of the permanent teeth in both dental arches tended to be smaller in children born prematurely than full term children. Subgroup analyses showed statistically significant differences for the extremely preterm to control group comparisons for the incisors and the first molars. Meta-regression showed a modificatory effect of gestational age and racial background but not of birth weight and gender on tooth size. The quality of available evidence was rated at best as moderate. Conclusions Premature birth could potentially be associated with reduced tooth-crown dimensions in some permanent teeth especially in children born extremely preterm. Although the results from these observational studies should be approached with caution until more information becomes available, the possible clinical implications in terms of diagnosis and treatment planning should be considered. Registration PROSPERO (CRD42020182243).