Purpose: The aim of this clinical retrospective study was to evaluate the survival and success of single metal-ceramic crowns after 20 years. The biologic and technical complications as well as patient satisfaction were recorded. Materials and Methods: Fifty patients treated with 100 single metal-ceramic crowns attended the clinical 20-year follow-up examination. The mean follow-up time was 18.8 years (17.5 to 20.5 years). Results: Twenty-one teeth with single crowns were extracted because of root fractures or esthetic or periodontal reasons. Ninety-seven percent of the subjects had no complaints about the esthetics of the crowns. The most common clinical findings were supragingival crown margins caused by gingival recessions, gingival bleeding on probing, and occlusal wear in opposing teeth. The success of the crowns after 20 years was 75%, and the survival was 78%. Conclusion: In the 20-year follow-up of single metal-ceramic crowns, there were few biologic and technical complications, and patients were satisfied with the crowns. Crown removal was in most cases the result of root fractures in single crowns with endodontic posts.