Hydrophobic or hydrophilic fissure sealants: A systematic review and meta-analysis

ABSTRACT Objectives: The objective of the study was to evaluate caries development and retention rate of resin-based hydrophilic and hydrophobic fissure sealants based on the randomized clinical trials in which the investigators have studied this subject. Materials and Methods: A literature screen was conducted in some databases, including PubMed, Scopus, Embase, ISI Web of Science, and Cochrane Library, to select randomized clinical trials that compared the caries development/retention rate of resin-based hydrophilic and hydrophobic fissure sealants until March 2025. The risk of bias of the included studies was assessed using version 2 of the Cochrane risk-of-bias tool for randomized trials (RoB 2), and the meta-analysis was performed using a random-effect model. The quality of evidence was assessed using the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) approach. Results: A total of 20,945 articles were initially retrieved for screening, and fourteen studies were identified as eligible for inclusion in the quantitative analysis. The RoB assessment showed a high risk of bias in 5 studies, some concerns in 5, and low risk in 4. Caries development was reported in 11 studies, and retention rate in 14. The meta-analysis results showed a statistically significant difference for caries development (odds ratio OR: 0.490, 95% confidence interval CI: 0.277–0.867; P = 0.014), whereas the retention rate (OR: 0.859, 95% CI: 0.596–1.237; P = 0.414) indicated no statistically significant differences. The quality of evidence for both outcomes was rated as very low according to the GRADE system. Conclusion: It could be concluded that hydrophilic and hydrophobic resin-based fissure sealants are approximately equal in caries development and retention rate, with very low quality of evidence. Clinical Relevance: In clinical practice, resin-based hydrophilic fissure sealants could be applied on susceptible tooth surfaces; in case of difficult isolation, with an almost equal clinical success for hydrophobic fissure sealants.