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Studies examining the efficacy of sealing occlusal caries lesions in the primary dentition are limited, and no studies have so far examined the efficacy of infiltrating occlusal lesions on primary molar teeth.This study aimed to evaluate the efficacy of infiltrating, sealing, or fluoride varnishing on the occlusal surfaces with initial caries lesions.Split-mouth design study was carried out with 50 children aged between 5 and 8 years with three occlusal lesions. After randomization, one lesion was infiltrated with ICON and varnished with Duraphat (I+F), one lesion was sealed with Delton and varnished with Duraphat (S+F), and one lesion only varnished with Duraphat (F).Lesion status could be followed on radiographs on 47 children after 2–3 years (mean=22 months). Seven lesions in the I+F group, 9 lesions in the S+F, and 17 lesions in the F group showed radiographic progression. A significant difference in lesion progression was only found between the I+F- and the F group of teeth (P = 0.021).Infiltration and sealing occlusal surfaces with initial caries lesions on primary molar teeth showed a high efficacy in arresting caries progression, significant for the I+F or borderline significant for the S+F compared with the F group.