Dental caries remains one of the most prevalent chronic diseases affecting children worldwide, particularly in the primary dentition. The occlusal surfaces of primary molars, characterized by deep pits and fissures, are especially susceptible to carious lesions due to their complex morphology and the challenges they present in effective cleaning. As a preventive strategy, the application of pit and fissure sealants (PFS) has gained widespread acceptance for its ability to provide a physical barrier against cariogenic biofilm accumulation and acid attacks. Resin-based sealants, in particular, are preferred for their superior retention and sealing ability. However, the clinical success of these sealants depends heavily on the quality of adhesion to the enamel surface, which is influenced by several factors, including the condition of the enamel at the time of application.

One of the major impediments to optimal adhesion is the presence of an organic pellicle on the enamel surface. This proteinaceous layer, which includes salivary proteins and microbial products, can compromise the effectiveness of acid etching by preventing adequate penetration and demineralization of the enamel surface. Traditionally, acid etching with phosphoric acid has been employed to increase surface roughness and create microporosities for micromechanical retention. However, the presence of organic contaminants can hinder the etching process and reduce the sealant’s retention rate and longevity.

Enamel deproteinization is a pre-treatment technique that involves the use of agents such as sodium hypochlorite (NaOCl) to remove organic components from the enamel surface before acid etching. This step is believed to enhance the efficacy of the etching process by exposing more of the enamel’s mineral content, thereby improving resin tag formation and ultimately increasing bond strength. Several in vitro studies have demonstrated improved enamel surface morphology and enhanced bonding performance following deproteinization. However, there is limited high-quality clinical evidence to support the routine use of enamel deproteinization prior to sealant application, particularly in primary teeth, where enamel composition and structural differences may influence outcomes.

Given the potential benefits of enamel deproteinization, it is imperative to evaluate its effectiveness under clinical conditions. Primary molars, with their high caries susceptibility and relatively short lifespan, present a unique opportunity to assess preventive interventions in a meaningful timeframe. Additionally, children in the primary dentition phase may present behavioral management challenges that necessitate efficient and reliable treatment protocols. Therefore, techniques that enhance sealant retention and reduce the need for retreatment are of significant value in pediatric dentistry.

This study aims to evaluate the clinical performance of resin-based pit and fissure sealants in primary molars following enamel deproteinization prior to acid etching, using a randomized controlled trial design. The primary objective is to determine whether the additional step of enamel deproteinization improves sealant retention and reduces marginal discoloration and caries development over time. Secondary objectives include assessing the practicality of the procedure in a clinical pediatric setting and determining any potential adverse effects associated with the use of deproteinizing agents.

By providing robust clinical evidence through a well-designed randomized controlled trial, this research seeks to inform best practices for the application of pit and fissure sealants in young children. The findings may contribute to the development of more effective preventive protocols, ultimately improving oral health outcomes in the pediatric population. If enamel deproteinization proves beneficial, it could be incorporated into standard clinical procedures, thereby enhancing the long-term success of sealant therapy and reducing the burden of dental caries in children.