Clinical performance of resin infiltration and different sealant modalities in noncavitated pits and fissures: a split-mouth randomized controlled trial.

OBJECTIVES: To compare the clinical performance of resin infiltration and different pit and fissure sealants in young permanent molars. METHOD AND MATERIALS: This split-mouth randomized controlled trial evaluated 128 permanent molars with non-cavitated occlusal lesions (ICDAS 0-2) in 32 children aged 7-14 years. Teeth were randomly allocated to four groups (n = 32/group): resin infiltration (Group A), moisture-tolerant resin sealant (Group B), flowable nanohybrid composite (Group C), and combination of group A and C (Group D). Outcomes assessed were ICDAS scores, DIAGNOdent values, marginal integrity, marginal discoloration, retention at baseline, 6, and 12 months using generalized estimating equations (GEE) (P < .05). RESULTS: Significant reduction or stabilization in ICDAS scores occurred over time across all groups (P < .001). Group A demonstrated significantly higher likelihood of ICDAS stabilization than Group C (OR = 1.85; 95% CI = 1.10-3.12; P = .021). Group D showed significantly lower lesion progression than Group B (OR = 1.72; 95% CI = 1.05-2.95; P = .034). At 12 months, retention was high, with only 6 teeth requiring revision (Group A: n = 1; Group B: n = 2; Group C: n = 3; Group D: n = 0). No significant intergroup differences in DIAGNOdent values or marginal integrity were observed (P > .05). CONCLUSION: All four evaluated modalities demonstrated significant short-term cariostatic activity. Infiltration-based approaches, particularly the combination approach, demonstrated superior clinical performance by yielding minimal lesion progression, high retention rates, and the lowest incidence of clinical revision in high-caries-risk children.