BACKGROUND: Dental sealants are critical in preventing caries by protecting pits and fissures from food and microorganism accumulation. Sealants are categorized as hydrophobic and hydrophilic. Hydrophobic sealants exhibit higher retention but less effective in moist environments, hydrophilic sealants perform better under such conditions. Evaluating retention and caries prevention efficacy of these sealants is essential for optimizing dental care practices. This review evaluates retention and caries preventive efficacy of both sealants. MATERIALS AND METHODS: Data on study design, sample size, sealant type, follow-up duration, retention rates, and secondary caries incidence were extracted. The risk of bias assessed using RevMan 5.4, and meta-analyses were conducted with both random-effects model and fixed-effects model based on heterogeneity and nature of included studies. RESULTS: Adhering to PRISMA guidelines, 15 Randomized Controlled Trials (RCTs) and 3 Non-Randomized Controlled Trials (NRCTs) met with inclusion criteria. Hydrophilic sealants showed significantly higher retention rates at 3 months (OR: 3.00, 95 % CI: 1.46-6.16) and 12 months (OR: 2.00, 95 % CI: 1.35-2.96). However, no significant differences observed at 6, 9, and 18 months. Caries prevention efficacy was similar for both sealant types across all follow-up periods, with low heterogeneity indicating consistent results. DISCUSSION: Hydrophilic sealants initially provide better retention due to moisture-resistant properties but do not sustain this advantage in long run. Both sealant types are equally effective in preventing caries. These findings align with prior studies, emphasizing importance of moisture control in sealant application. CONCLUSION: Hydrophilic sealants exhibit superior short-term retention and similar caries prevention efficacy compared to hydrophobic sealants.