Stainless steel crowns have been proved to be successful and efficient full coverage restoration in pediatric dentistry especially after pulp therapy and for restoring multi-surface carious lesions. These crowns are usually pre-formed and are selected according to the size of the tooth that requires the crown. The purpose of this study is to determine the common reasons for requirements of back to back stainless steel crowns in the maxillary arch of children aged 2 to 6 years. This cross sectional observational study was carried out retrospectively by analysis of the case sheets for the treatment done with back to back stainless steel crowns in the right and left quadrants of maxillary arch and thereby determining the requirements for the same. Out of 69 pairs of back to back crowns, 90.4% of the teeth required pulpal treatments; 8% of the teeth required Class II restorations; 11% of the teeth were given back to back crowns as an abutment for space maintainers in the upper arch. Back to back crowns in the maxillary arch were placed mostly for teeth treated by pulpectomy, followed by abutments for space maintainers.