Longevity of stainless steel crowns in molar incisor hypomineralization: a systematic review

Background Molar incisor hypomineralization (MIH) is a developmental enamel defect frequently affecting permanent first molars, often leading to hypersensitivity, post-eruptive breakdown, and restorative failure. The compromised mechanical and adhesive properties of hypomineralized enamel make restorative management challenging, particularly in severe cases. Stainless steel crowns (SSCs) are widely advocated for full coronal coverage in such teeth; however, variability in reported outcomes and the increasing use of alternative restorative materials necessitate a systematic evaluation of their clinical performance. Objective This systematic review aimed to compare the survival and clinical success of stainless steel crowns with alternative restorative approaches in the management of severely MIH-affected permanent molars in children and adolescents. Methods The review was conducted in accordance with PRISMA guidelines and the Cochrane Handbook for Systematic Reviews of Interventions. Electronic searches were performed in PubMed, Scopus, Web of Science, and the Cochrane Library up to December 2025. Studies involving children aged 6–15 years with severe MIH affecting permanent first molars were included. Interventions comprising SSCs were compared with composite restorations and other full-coverage crowns. Eligible study designs included randomized controlled trials, retrospective studies, and clinical observational studies. Risk of bias was assessed using the Newcastle–Ottawa Scale. Due to heterogeneity among studies, a qualitative narrative synthesis was performed. Results Five studies met the inclusion criteria. Across all included studies, stainless steel crowns demonstrated consistently higher survival and success rates compared with composite restorations and ceramic crowns over follow-up periods ranging from 12 to 24 months. SSCs showed superior retention, marginal integrity, and reduced need for retreatment, particularly in teeth with extensive enamel breakdown and hypersensitivity. Alternative restorations, especially multi-surface composite restorations, exhibited higher failure rates over time. Conclusion Within the limitations of the available evidence, stainless steel crowns exhibit superior clinical survival and success compared with alternative restorative techniques in the management of severely MIH-affected permanent molars. SSCs remain a reliable, durable, and cost-effective treatment option for children with severe MIH. Further high-quality randomized controlled trials with longer follow-up periods and standardized outcome measures are required to strengthen the evidence base. Systematic Review Registration PROSPERO CRD420251274395.