Survival Analysis of Stainless Steel Crowns in Children with Early Childhood Caries Treated under General Anesthesia

The aim of this study is to compare long-term survival, failure patterns, and risk factors of stainless steel crowns (SSCs) versus resin composite (RC) restorations placed on primary molars of children with early childhood caries (ECC) treated under dental general anesthesia (DGA). A retrospective chart review was performed for 111 children (579 teeth) at the Department of Pediatric Dentistry, Jeonbuk National University Dental Hospital, from January 2014 to December 2024. Survival up to 84 months was estimated by Kaplan-Meier analysis and failure risk was assessed using Cox proportional hazards models. SSCs demonstrated consistently higher survival than RC (p < 0.0001), with RC exhibiting an > 8-fold higher failure risk relative to SSC (hazard ratio 8.573; 95% CI, 5.04 – 14.60; p < 0.0001). This material effect persisted regardless of age, sex, systemic disease, or pulp therapy status. Within the RC subgroup, younger age and mandibular first primary molars were associated with inferior survival. Secondary caries predominated in RC failures (83.7%), whereas inflammation accounted for 50.0% of SSC failures. Notably, 36.7% of failed RC restorations were retreated with SSCs. In ECC patients treated under DGA, restorative material is the dominant determinant of longevity. SSCs provide markedly superior long-term outcomes and should be prioritized as the initial restorative option to minimize failure, retreatment, and repeat anesthesia. These findings apply to high-risk ECC populations and may not generalize to lower-risk outpatient settings.