Bonding Agents Under Sealants Showed No Consistent Caries Benefit in Review

Edited by Dentaltown staff

Applying a bonding agent before placing a pit-and-fissure sealant improved retention in some trials but produced no consistent additional reduction in caries, according to a systematic review published Sept. 10 in BMC Oral Health.

Researchers searched PubMed/MEDLINE, Embase, Web of Science, the Cochrane Library, and Scopus from inception through Jan. 30, 2026, for randomized controlled trials comparing sealants placed with and without a bonding agent after acid etching. Risk of bias was assessed with Cochrane RoB 2, findings were synthesized narratively, and certainty of evidence was rated using GRADE.

Ten publications representing nine randomized split-mouth trials and 581 unique children met the inclusion criteria.

Several trials reported higher sealant retention when a bonding agent was used, while others found little or no additional benefit. Results varied with adhesive strategy, tooth substrate, isolation method, the criteria used to score retention, and length of follow-up.

On the caries outcome, new lesions on initially sound teeth were generally uncommon across the trials, and no consistent additional benefit from bonding was demonstrated. One trial examined progression of pre-existing lesions scored ICDAS 2 through 4 and reported that progression was rare, with no significant difference between groups.

Certainty of evidence was rated very low for retention, low for incidence of new caries, and very low for progression or control of pre-existing lesions.

The authors concluded that bonding agents may improve retention in some clinical settings, that the magnitude and persistence of any such benefit remain uncertain, and that current evidence does not demonstrate a consistent additional benefit for caries outcomes.

Dae-Woo Lee, Nourhan Mohamed, Xuan Minh Quan Dao, and Van Nhat Thang Le conducted the review, which was registered with PROSPERO.

No pooled estimate was produced. The authors attributed that to how the split-mouth trials reported their data and called for future trials to report paired binary outcomes or appropriately adjusted effect estimates so quantitative synthesis becomes possible.

Sources:
BMC Oral Health, “Retention and caries outcomes of pit-and-fissure sealants with versus without a bonding agent: a systematic review,” published online Sept. 10, 2026: link.springer.com/10.1186/s12903-026-09842-x