Are resin sealants effective to treat caries lesions in the outer 1/3 of dentin compared to composite resin restorations? Systematic review and meta-analysis

This systematic review analyzed effectiveness of resin sealants in arresting caries lesions in the outer 1/3 of dentin compared to restorations in deciduous/permanent teeth. Seven databases were searched for randomized clinical trials (December/2024), considering the outcomes "caries progression", "material retention", "tertiary dentin formation", with a minimum 6 months follow-up. Risk of bias was assessed with RoB 2; meta-analysis used risk difference as effect measure in random effects model and Cochran Q test / I² statistics for heterogeneity; GRADE assessed the evidence certainty. From 6251, 6 papers addressing deciduous (3 high; 3 low risk of bias) and 3 permanent teeth (1 high; 2 low) were included. In deciduous teeth, difference wasn't observed for "caries progression" [0.02 (-0.04-0.08; p = 0.54); I²= 0 % (p = 0.79)] or "material retention" [0.09 (-0.01-0.19); I²= 35 % (p = 0.18)]. In permanent teeth, there was no difference for "caries progression" [-0.01 (-0.08-0.06); I² = 30 % (p = 0.23)] and "tertiary dentin" [0.04 (-0.00-0.09); I² = 0 % (p = 0.51)]; "material retention" favored restorations after 48 months [0.08 (0.04-0.12); I² = 0 % (p = 0.34)]. In conclusion, sealants can be used to treat initial dentin caries lesions in deciduous and permanent teeth; however, the certainty of the evidence is low and moderate, respectively, and the findings must be taken carefully.