Fissure sealants – are self-etch sealants more effective?


There is good evidence for the effectiveness of fissure sealants for the prevention of caries (Ahovuo-Saloranta et al 2013). Sealant retention is important in maintaining this benefit and it has been suggested that use of adhesive systems prior to sealant application may improve retention.

The aim of this review was to assess whether self-etch adhesive sealants were as effective as traditional acid etching, with or without the application of adhesive system.


Searches were conducted in the Cochrane Central Register of Controlled Trials (CENTRAL), Medline and databases. Randomised controlled trials (RCTs) evaluating the effectiveness of self-etch systems compared to acid-etching technique prior to sealants in occlusal surfaces and published in English were considered. Two reviewers independently selected studies and assessed quality and risk of bias and meta-analysis conducted.


  • 5 split-mouth studies were included.
  • Studies were conducted in Egypt, Pakistan, Scotland, Turkey and the United States.
  • Follow up periods ranged from 6 to 24 months.
  • 1 study involved primary molars, 4 permanent molars.
  • There was a significantly lower failure rate in the control group (acid-etching technique). Odds ratio = 4.46 (95% CI 1.31, 15.20); P < 0.0001; I2 = 85%.


The authors concluded:

Occlusal sealants applied with self etch systems show lower retention throughout time than sealants applied in the conventional approach, regardless of the use of adhesive systems.


The authors have employed a broad search strategy employing a number of databases although the restriction of included studies to those published in English may have resulted in excluding some relevant studies.

Only 5 split-mouth studies could be included with the largest of them including 91 teeth (range 18-91 teeth). The included studies also demonstrate important heterogeneity of materials, evaluation criteria and follow up times. The age of sealant application also varies with 1 study involving primary teeth and another involving young adults aged 18-21. These issues should be taken into consideration when interpreting the findings of this review.


Primary paper

Botton G, Morgental CS, Scherer MM, Lenzi TL, Montagner AF, Rocha RO. Are self-etch adhesive systems effective in the retention of occlusal sealants? A systematic review and meta-analysis. Int J Paediatr Dent. 2015 Nov 21. doi:10.1111/ipd.12214. [Epub ahead of print] Review. PubMed PMID: 26590954.

Other references

Review protocol on PROSPERO database

Ahovuo-Saloranta A, Forss H, Walsh T, Hiiri A, Nordblad A, Mäkelä M, Worthington HV. Sealants for preventing dental decay in the permanent teeth. Cochrane Database of Systematic Reviews 2013, Issue 3. Art. No.: CD001830. DOI: 10.1002/14651858.CD001830.pub4.

 Dental Elf – 8th Apr 2013 – Review recommends fissure sealants for caries prevention in permanent teeth

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Derek Richards

Derek Richards is a specialist in dental public health, Director of the Centre for Evidence-Based Dentistry and Specialist Advisor to the Scottish Dental Clinical Effectiveness Programme (SDCEP) Development Team. A former editor of the Evidence-Based Dentistry Journal and chief blogger for the Dental Elf website until December 2023. Derek has been involved with a wide range of evidence-based initiatives both nationally and internationally since 1994. Derek retired from the NHS in 2019 remaining as a part-time senior lecturer at Dundee Dental School until the end of 2023.

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