This randomized clinical trial aims to evaluate the efficiency of the Dry-Shield isolation system compared with rubber dam isolation and cotton roll isolation during fissure sealant application in permanent molars among pediatric patients.

The study evaluates chairside time, patient preference, and fissure sealant retention rates after 6 and 12 months of follow-up. Proper isolation during fissure sealant application is considered essential for optimal retention and long-term clinical success.

The study also aims to assess whether Dry-Shield can provide a practical and comfortable alternative to conventional isolation techniques in pediatric dentistry.

Fissure sealants are widely used preventive measures for reducing occlusal caries in permanent molars. Successful sealant retention largely depends on adequate moisture control during application. Rubber dam isolation has traditionally been considered the gold standard for moisture control; however, its use in pediatric dentistry may be associated with increased chair time and patient discomfort.

Dry-Shield is an isolation device that combines suction, tongue retraction, bite block support, and moisture control in a single system. This may improve clinical efficiency and patient comfort during dental procedures.

This randomized clinical trial compares the Dry-Shield isolation system with rubber dam isolation and cotton roll isolation during fissure sealant application in permanent molars in children. The study evaluates clinical efficiency through assessment of chairside time, patient preference, and fissure sealant retention at 6 and 12month follow-ups.

Inclusion Criteria:

A- Patient inclusion criteria:

1. Cooperative, apparently healthy children.
2. Each child had at least three fully erupted first and/or second permanent molars.
3. Patient being at high risk of dental caries.
4. Informed consent was filled before treatment.

B- Molar inclusion criteria:

1. Tooth had deep pits and fissures.
2. Molars with the International Caries Detection and Assessment System (ICDAS) score 0-2.
3. All three molars required PFS.

Exclusion Criteria:

A- Patient exclusion criteria:

1. Uncooperative children.
2. Children with special needs.
3. Children who required emergency dental care (draining sinus, abscess and cellulitis).
4. Who were suffering from an allergy to latex or a severe gag reflex.
5. Mouth breather or child with nasal obstruction.
6. Children with fixed orthodontic.

B- Molar exclusion criteria:

1. Previous restored or carious first or second permanent molars.
2. Molars with anomalies of the enamel or dentin.

To protect patient privacy and maintain confidentiality, individual participant data will not be made publicly available