Abstract

Prevention of occlusal caries has been a longstanding challenge in dentistry, evolving appropriately from invasive mechanical techniques toward increasingly adhesive and bioactive strategies. Early attempts, such as the application of silver nitrate and preventive restorations, were limited by questionable efficacy and unnecessary removal of sound tooth structure. The advent of adhesive dentistry and the acid-etching technique enabled the development of resin-based sealants, providing a minimally invasive and effective method for fissure protection. Over time, sealant materials have evolved through four generations, introducing improved polymerization mechanisms, fillers, and fluoride release to enhance wear resistance, retention, and antibacterial properties.

However, conventional glass ionomer cements (GICs) demonstrate lower mechanical strength and retention compared to resin-based sealants. Subsequently, resin-modified GICs were developed to address these shortcomings while maintaining fluoride release. More recently, hybrid materials such as compomers and giomers have combined the advantages of composites and GICs, offering improved adhesion, esthetics, and release of bioactive ions—although their fluoride release remains lower than that of conventional GICs.

Overall, the evolution of pit and fissure sealants reflects a transition from invasive preventive approaches to minimally invasive, bioactive, and fluoride-releasing materials.

Keywords

glass ionomer cements, hybrid materials, occlusal caries prevention, pit and fissure sealants

Introduction

The susceptibility of occlusal surfaces to dental caries has been recognized for more than two centuries and remains a subject of continuous clinical and scientific interest. The complex morphology of pits and fissures on molars promotes plaque retention and creates conditions favorable for cariogenic biofilm development, rendering these surfaces particularly vulnerable despite advances in preventive dentistry.^[1]

Early attempts at occlusal caries prevention date back to the beginning of the 20th century. In 1905, Willoughby Miller reported the antibacterial properties of silver nitrate and proposed its application to occlusal surfaces to reduce microbial colonization.^[2] Subsequently, in 1921, Hyatt introduced the concept of prophylactic Class I cavity preparation followed by amalgam restoration on sound permanent molars as a preventive measure against occlusal caries development.^[3] For several decades, preventive strategies were largely based on mechanical alteration of pits and fissures aimed at reducing plaque retention. However, these approaches were characterized by questionable preventive efficacy and often resulted in unnecessary removal of healthy tooth structure, while simultaneously contributing to artificially increased DMF index values.^[3,4]

A decisive shift toward conservative prevention occurred with the advent of adhesive dentistry. The development of the acid-etch technique by Buonocore in 1955, followed by the introduction of resin-based materials such as bisphenol A-glycidyl methacrylate (Bis-GMA) in the late 1960s, enabled the concept of sealing rather than removing susceptible tooth structures.^[4,5,14] Pit and fissure sealants emerged as a minimally invasive and evidence-based method for occlusal caries prevention, demonstrating superior clinical outcomes compared with earlier invasive approaches.^[6]

Over subsequent decades, preventive materials have undergone continuous development. Resin-based sealants evolved through multiple generations with improvements in polymerization, filler content, and wear resistance.^[6,7] Glass ionomer cements introduced chemical adhesion and sustained fluoride release, expanding preventive options in patients with high caries risk or compromised moisture control.^[8] More recently, hybrid materials such as compomers and giomers have been developed to combine the mechanical properties of resin composites with the fluoride-releasing and bioactive characteristics of glass ionomer-based systems.^[9-11]

Sealants

By definition, a sealant is an organic polymer applied to the occlusal surface after acid etching of enamel.^[11] Until the mid-1960s, the most common prophylactic occlusal sealant material was methyl cyanoacrylate.^[12,13] One-year outcomes showed 71% material retention and an 87% reduction in caries. However, long-term use revealed poor resistance to bacterial invasion and compromised performance.^[2]

Sealants developed over time are classified based on various criteria. In 1965, Bowen introduced a Bis-GMA-based sealant characterized by bacterial resistance and stable bonding to etched enamel.^[12] Composite sealants consist of an oligomeric Bis-GMA matrix and inorganic silica filler, linked via a coupling agent such as silane.^[15] The first commercially introduced sealant, Nuva-Seal (LD Gaulk, Milford, DE), appeared in 1971.^[16-18]

Based on polymerization mechanism, sealants are grouped into four generations:

First generation: cyanoacrylates polymerized via UV light (~365 nm). Due to low durability, these were withdrawn from the market. ^[19]
Second generation: Bis-GMA or urethane dimethacrylate based, either self- or chemically polymerizing. ^[19,20] These exhibited inadequate performance, primarily due to moisture contamination of etched enamel and incomplete material penetration. ^[21,22]
Third generation: it includes diketone activators and reducing agents, polymerized under visible light. ^[23]
Fourth generation: fluoride-releasing materials providing added caries preventive benefits. ^[20,24]

To enhance wear resistance, fillers such as glass beads, quartz particles, sodium fluoride, zirconia, or silica were added to sealants.^[25,26] Sealants can thus be categorized as either filled or unfilled. Notably, adoption of filler increases viscosity, which inversely affects penetration and retention—unfilled sealants exhibit deeper fissure penetration and stronger adhesion.^[27-29]

Sealants may be clear, opaque, or colored.^[30] White or tinted sealants facilitate evaluation of application accuracy and material wear during follow-up.^[31]

The preventive and therapeutic efficacy of sealants is enhanced by fluoridation. Two mechanisms have been identified for the introduction of fluoride ions: (1) adding soluble fluoride salts into the unset sealant, which release ions post-application, although this may compromise mechanical properties; and (2) incorporating organic fluoride compounds into the sealant structure, where ions are released via anion exchange without weakening the matrix.^[32]

Most dental materials elevate enamel surface energy and tend to retain bacterial biofilm at restoration margins. Fluoride reduces surface energy and inhibits enamel demineralization during acid attacks. Additionally, fluoride inhibits bacterial growth and may exhibit lytic effects on cariogenic strains like S. mutans.^[54]

Fluoridated sealants thus provide both a mechanical barrier and facilitate remineralization. The long-term fluoride-release capacity of composite sealants and glass-ionomer cements correlates with reduced caries incidence in children.^[32] For instance, the glass-ionomer cement Fuji Triage releases a high initial burst of fluoride in deionized water during the first week, followed by sustained lower-level release.^[32] Composite sealants exhibit a pronounced 24-hour “burst effect,” followed by gradual decline.^[33,34]

The reservoir capability of a material depends on its type, permeability, frequency of fluoride exposure, and fluoridating agent concentration.^[32] Glass-ionomers have superior reservoir properties compared to composites^[35], likely due to loosely bound water and soluble components that permit ion exchange via diffusion. Materials with high permeability can absorb fluoride deeply, while less permeable ones absorb it only superficially.^[35] Consequently, the modest increase in fluoride release from composite sealants after exogenous fluoride exposure is attributed to surface adsorption. Overall, variants with high initial fluoride release exhibit greater recharge capacity.^[32]

Glass-ionomer cements

Conventional glass-ionomer cement

In 1974, McLean and Wilson utilized glass-ionomer cement (GIC) as an occlusal sealant material.^[36] It bonds chemically to enamel while concurrently releasing fluoride ions at the enamel interface.^[36,37] GICs are preferred when tooth eruption is incomplete (pre-sealant stage), an operculum is present, and moisture control is suboptimal due to their hydrophilic nature.^[37,38] Moreover, their sustained low-dose fluoride release contributes to anticaries effects.^[39]

However, GICs exhibit lower flexural strength, higher abrasion and wear rates, and reduced penetration and retention on occlusal surfaces. Compared to conventional sealants, they are more prone to staining and plaque accumulation.^[40-43]

A seven-year clinical study comparing light-curing sealants and GICs for prophylactic sealant application found that conventional sealants exhibited superior retention, which was attributed to the higher viscosity of GICs. The study also reported a higher incidence of caries in the GIC group.^[44] Other authors corroborate that GICs are less cost-effective due to the need for frequent repair or reapplication, owing to faster wear.^[45-47] Conversely, some investigations have reported no caries development after using GICs on deep occlusal fissures, considering them suitable for preventive application.^[37,48] GIC adheres chemically (ionically) to tooth structure, forming stronger bonds with enamel than dentin due to enamel’s higher inorganic content. Adhesion involves chelation between carboxyl groups in polyacrylic acid and calcium in hydroxyapatite crystals.^[37,38]

Resin-modified glass-ionomer cements

Introduced in 1989, resin-modified GICs were developed to overcome the weaknesses of conventional GICs—namely, poor mechanical strength, wear resistance, and esthetics—while retaining fluoride release and clinical ease. These materials combine resin polymerization with acid-base reactions characteristic of GICs, including a resin component such as 2-hydroxyethyl methacrylate (HEMA), typically initiated with camphorquinone for light curing. Despite improved mechanical properties, the material displays reduced moisture resistance.^[19,49-51]

Hybrid sealants – compomers and giomers

These materials combine composite and GIC properties. Polyacid-modified composite resins (compomers) were introduced as restorative materials in 1990.^[52] They offer lower viscosity and good flowability, enabling excellent penetration. Compared to conventional GICs, compomers demonstrate improved adhesion to tooth structures and lower solubility in water.^[52,53] However, their fluoride release is lower and less effective than that of conventional or resin-modified GICs.^[54]

Giomers are urethane-based materials containing pre-reacted glass-ionomer filler particles, which impart fluoride release, although at significantly lower levels than GICs.^[50,55,56] They represent a class of composites offering caries protection and favorable functional and esthetic outcomes via incorporation of pre-reacted glass fillers.^[57] Marginal adaptation and postoperative sensitivity are comparable to those of composites and giomers, but the risk of secondary caries is reduced with newer materials.^[57] Bioactive glass in giomers dissolves upon contact with biological fluids, enabling therapeutic release of phosphate, fluoride, and calcium ions, thereby enhancing apatite formation.^[10,58] Their use is recommended across all restoration classes, particularly in high-risk caries patients, for correct restorative of gingival esthetics in cervical areas using existing gingival-shade liners and sealants.^[57]

The bioactive glass components in giomers dissolve upon contact with biological fluids, enabling therapeutic release of phosphate, fluoride, and calcium ions that may enhance apatite formation and remineralization.^[9] A randomized clinical study comparing giomer‑based sealants versus conventional resin‑based sealants found similar retention rates and caries preventive effects over a 12‑month period in permanent molars with non‑cavitated fissures, suggesting that giomer capture of caries risk reduction may be on par with resin when adequately applied.^[11] This indicates that, despite material differences, both giomer and resin sealants can be clinically effective in short‑term caries prevention. Another randomized clinical trial specifically evaluated giomer S‑PRG pit and fissure sealants with or without preparatory enamel etching over one year and demonstrated that performing an etching step significantly enhanced retention rates, with etched giomer sealants showing higher survival than unetched application.^[11] These findings underscore the importance of clinical technique in optimizing hybrid sealant performance. While direct long‑term randomized data comparing compomers and giomers are limited, a clinical comparative study of multiple sealant materials including compomer demonstrated that compomer sealants can achieve intermediate retention levels between resin‑based and GIC sealants over 24 months, with no new caries formation observed in both compomer and resin groups throughout follow‑up.^[4,6] This supports the concept that compomers provide a balance between mechanical performance and cariostatic benefit, though retention declines over time. Although not focused exclusively on hybrid sealants, broader clinical evidence consistently shows that retention rates vary substantially by material type and that resin‑based sealants generally outperform other categories in long‑term retention, whereas differences in caries incidence across materials tend to diminish when sealants are properly maintained.^[1,3]

The available clinical evidence includes randomized trials and comparative studies with follow‑up periods ranging from 12 to 24 months. While these provide useful insights, limitations exist due to heterogeneity in study designs, sealant application methods, and outcome measures. Longitudinal data beyond 2 years remain relatively sparse, and systematic reviews indicate that further high‑quality trials with standardized retention and caries outcomes are needed to strengthen clinical recommendations, particularly for hybrid sealant classes.^[1,3]

Discussion

Recent systematic reviews provide robust evidence supporting the clinical effectiveness of pit and fissure sealants in caries prevention, while simultaneously highlighting material-dependent differences in retention, fluoride release, and handling characteristics (Table 1). According to the comprehensive review by Ng et al.^[1], resin-based sealants consistently demonstrate superior retention compared with glass ionomer-based materials, which is largely attributed to their micromechanical bonding to etched enamel. This finding is further corroborated by clinical meta-analyses showing that retention remains a key determinant of long-term caries prevention when optimal isolation is achieved.^[2,6]

Table 1.

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Comparative table: resin, glass ionomer, compomer & giomer sealants

Material Parameter	Resin-based sealants	Glass ionomer sealants (GIC)	Compomer sealants	Giomer sealants
Material Basis	Polymer resin (methacrylate)^[1]	Acid-base setting fluoroaluminosilicate glass^[17]	Resin matrix + ion-releasing glass particles^[1,3]	Resin matrix with S-PRG (surface prereacted glass ionomer) fillers^[1,9]
Retention / Adhesion	Generally the highest retention — strong mechanical bond with etched enamel^[1,4]	Historically lower retention than resin, though high-viscosity GICs can perform similarly in certain protocols (e.g., ART)^[4,5]	Intermediate retention — typically better than GI, sometimes competitive with resin, dependent on formulation^[4]	Variable; sometimes lower than conventional resin sealants; product-dependent^[4,9]
Fluoride release & cariostatic action	Low to moderate fluoride release (if present)^[3]	High fluoride release and recharge potential — sustained release helps remineralization and cariostatic effect^[3,7]	Fluoride release greater than resin but less than GICs^[3]	Fluoride release often intermediate; S-PRG fillers enable some recharge and multi-ion release^[3,9]
Caries prevention effect	Excellent barrier formation & strong preventive effect if well retained^[1,2,6]	Strong preventive potential via fluoride in high caries-risk environments^[2,3,6]	Moderate preventive effect (combined mechanical & fluoride)^[3,4]	Good effect with bioactive ion release, but less data than other classes^[3,9]
Technique sensitivity / Handling	Technique-sensitive — requires very dry field and precise etching & curing^[1,4]	Less technique-sensitive; tolerates moisture better — useful in pediatric or difficult isolation scenarios^[1,5]	Less sensitive than pure resin, but handling varies by product^[4]	Handling varies; similar to resin with some moisture advantage^[4]
Mechanical properties / Wear resistance	High wear resistance, durable in occlusal load^[1]	Lower mechanical strength; may be brittle if low viscosity; high-viscosity variants improve this^[7]	Intermediate; better than GI but lower than pure resin^[5]	Similar to resin, dependent on filler content^[5]
Best clinical use cases	Low caries risk patients when ideal isolation achieved & long retention desired^[1]	High caries risk patients, difficult isolation, pediatric cases, ART approaches^[10]	Situations needing moderate fluoride release + improved adhesion vs. GI^[5]	Bioactive roles where ion release + esthetics desired^[3]
Limitations / drawbacks	Moisture contamination may compromise retention; limited ion release^[1,8]	Historically poorer retention (depending on formulation), lower mechanical strength^[7,8]	Fluoride release lower than GI; outcomes can vary significantly by product^[3]	Mixed clinical evidence on long-term retention and effect^[4,9]

Conversely, systematic reviews focusing on fluoride dynamics emphasize the distinctive advantage of glass ionomer-based sealants. Dobrzyński et al.^[3] reported that glass ionomer materials exhibit significantly higher fluoride release and recharge capacity compared with resin-based sealants, which may compensate for their comparatively lower retention in high caries-risk populations. This cariostatic potential has been identified as particularly relevant in pediatric dentistry and in clinical scenarios where moisture control is compromised, as also discussed in ART-based systematic evaluations.^[5]

Hybrid materials such as compomers and giomers represent an attempt to combine the mechanical advantages of resin-based sealants with the bioactive properties of glass ionomers. However, recent systematic evidence suggests that these materials generally exhibit intermediate behavior rather than a true synergistic effect. Fluoride release from compomers and giomers is consistently lower than that of conventional glass ionomers, while their retention performance remains variable and product-dependent.^[3,4,9] Importantly, long-term meta-analytical data on giomer sealants remain limited, restricting the strength of clinical recommendations regarding their routine use.

Overall, the current body of systematic reviews and meta-analyses supports a risk-based and context-specific approach to material selection. Resin-based sealants remain the material of choice in low caries–risk patients under ideal isolation conditions, whereas glass ionomer sealants offer a clinically justified alternative in high caries-risk settings and pediatric populations where fluoride release and moisture tolerance are prioritized.^[3,5,6] Future high-quality meta-analyses with standardized outcome measures are needed to clarify the long-term clinical performance of hybrid sealant materials and to strengthen evidence-based guidelines.

Conclusion

Contemporary prevention of occlusal carious lesions is based on minimally invasive, adhesive, and fluoride-releasing materials supported by clinical evidence. Resin-based sealants provide the most predictable long-term retention under optimal isolation conditions, whereas glass ionomer cements represent a suitable alternative in high caries-risk patients and in situations with compromised moisture control due to their fluoride release. Hybrid materials demonstrate intermediate clinical performance, but current evidence is limited by short follow-up periods. Preventive material selection should be individualized according to caries risk and clinical conditions, and further long-term clinical studies are required to clarify the role of hybrid sealants.

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Additional information

Ethical statement

The author declared that no clinical trials were used in the present study.
The author declared that no experiments on humans or human tissues were performed for the present study.
The author declared that no informed consent was obtained from the humans, donors or donors’ representatives participating in the study.
The author declared that no experiments on animals were performed for the present study.
The author declared that no commercially available immortalized human and animal cell lines were used in the present study.

Conflict of interest

The author has declared that no competing interests exist.

Artificial Intelligence (AI) use

The author accept full responsibility for the content of the manuscript, including the disclosure of any use of AI. No AI tools were used in the preparation of this manuscript.

Funding

No funding was reported.

Author contributions

The author is solely responsible for this research which has not been previously published and is not currently under consideration by any other journal.

Author ORCIDs

Nedana Georgieva https://orcid.org/0000-0002-3393-1560

Data availability

All of the data that support the findings of this study are available in the main text.