Clinical Survival and Failure Patterns of Stainless Steel Crowns Under General Anesthesia in Pediatric Dentistry: A Systematic Review

Comprehensive dental rehabilitation under general anesthesia (GA) is often needed for young children with extensive caries, and failed restorations can mean repeat anesthesia. Stainless steel crowns (SSCs) are widely used for primary molars in this setting, but evidence on their survival and failure under GA is limited. This review evaluated SSC survival and failure patterns after placement under GA and the factors associated with failure. The review followed Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidance; the protocol was not registered. PubMed/MEDLINE, ScienceDirect, Web of Science, the Cochrane Library, and Google Scholar were searched from inception to January 31, 2026. Eligible studies enrolled children aged 16 years or younger who received SSCs under GA and reported survival or failure outcomes. Two reviewers independently selected studies, extracted data, and appraised the risk of bias with the Newcastle-Ottawa Scale. Because outcome definitions, units of analysis, and follow-up differed, results were not pooled; each estimate is reported with its own definition, follow-up, and 95% confidence interval (CI). A post hoc sensitivity analysis excluded studies that did not fully meet the age or GA criteria. Eight retrospective studies (2,797 children) were included. Seven reported SSC-level data, covering 7,256 SSCs placed under GA. Study-level survival or success ranged from 89.3% (5-year service time, Schüler) to 99.93% (12-month Kaplan-Meier estimate); examples are 97.2% (95% CI 96.6-97.7) at three years, 91.7% (89.5-93.5) free of retreatment at a second GA, and 89.7% (86.0-92.5) at two years. Reported failures included crown loss or debonding, open margins, recurrent caries, recementation, replacement, extraction, and perforation. SSCs had lower failure or retreatment rates than composite resins in four studies. Evidence against amalgam was inconsistent: Tate found significantly lower SSC failure, whereas Amin found no significant difference. Younger age and poor oral hygiene were associated with higher failure rates of dental procedures overall in one study, not SSC failure specifically. Pulpotomy did not significantly change two-year SSC survival (p = 0.283). SSCs placed under GA generally show favorable survival and lower failure rates than composite resin in retrospective studies with up to seven years of follow-up. Heterogeneous definitions, substantial loss to follow-up, and mostly non-SSC-specific risk-factor data prevent a pooled estimate or firm claims of superiority. Prospective studies with standardized SSC-specific outcomes are needed.