Pit and Fissure Sealants-from Evolution to Revolution: A Narrative Review

Abstract

Background: Occlusal pits and fissures of permanent molars remain the tooth sites most susceptible to dental caries in children and adolescents, and untreated caries of permanent teeth continues to be one of the most prevalent health conditions worldwide. Pit and fissure sealants have been used for more than five decades, yet their role has shifted from a purely preventive barrier towards an agent for managing early carious lesions, while a new generation of fluoride-releasing, ion-releasing, antibacterial and self-adhering materials is being promoted as transformative. Purpose and Scope: This critical narrative review examines the historical development of sealants, the strength of clinical evidence for their effectiveness, the performance of different material classes, the determinants of clinical success, safety concerns about bisphenol A, population-level delivery and the translational status of emerging bioactive and digital technologies. Approach: Literature published between January 1967 and 26 July 2026, together with foundational earlier work, was identified through structured searches of bibliographic databases, citation tracking and institutional sources, and was appraised for design, risk of bias, relevance and consistency. Principal Findings: The evidence is strongest for resin-based sealants on the occlusal surfaces of permanent molars, which reduce caries substantially compared with no sealant, although most trials are old and cannot blind outcome assessment. Sealing non-cavitated lesions reliably slows their progression. The relative merits of sealants and fluoride varnish, of resin-based and glass-ionomer materials, and of sealants in primary molars remain unresolved. Retention differs markedly between materials but predicts caries prevention poorly, which weakens retention as a surrogate outcome. Bioactive, antibacterial and self-adhering sealants show promising laboratory behaviour, but clinical evidence is short term, small scale and inconsistent. Bisphenol A exposure from sealants is transient and low, although long-term human data remain limited. Conclusions: The available evidence supports the incremental evolution of sealants more convincingly than a technological revolution. The more consequential change has been conceptual, as sealing is now understood as a microinvasive method of controlling lesion activity. Future progress depends on pragmatic, adequately powered trials with patient-relevant outcomes, standardised retention criteria and independent evaluation of new materials in primary teeth, hypomineralised molars, adults and underserved populations.