Retention of resin-based versus glass ionomer pit and fissure sealants in permanent molars: A systematic review of randomized clinical trials

Background: Pit and fissure sealants are a preventive strategy against occlusal caries in children. Resin-based sealants (RSs) are considered the gold standard because of their superior retention, while glass ionomer sealants (GIS) offer fluoride release and moisture tolerance. However, their comparative long-term performance remains unclear. Objective: To systematically compare retention rates, caries-preventive efficacy, and clinical performance of resin-based and GISs in children’s permanent molars. Materials and Methods: We searched PubMed, Scopus, Web of Science, and Google Scholar from database inception through September 30, 2025, for randomized controlled trials (RCTs) comparing resin based and GISs in permanent molars. The search strategy combined Medical Subject Heading and free-text terms related to sealants, permanent teeth, and pediatric populations. Risk of bias (RoB) was assessed using the Cochrane RoB 2.0 (RoB-2) tool. Certainty of evidence was not graded using GRADE. Results: A total of 13 RCTs were included. RSs showed consistently higher retention rates than GISs, while caries-preventive efficacy was generally comparable. Considerable heterogeneity was observed ( I 2 = 86.6%) due to differences in populations, sealant materials, and follow-up durations. RoB was assessed using the RoB-2 tool, and publication bias was evaluated using funnel plots and Egger’s test, which did not indicate small-study effects. Conclusion: RS outperforms GIS in retention, but both materials show comparable caries-preventive efficacy. GIS remains a viable alternative where isolation is difficult. Long-term RCTs with standardized outcome reporting are needed.