Comparison of Three Activating Methods of Irrigation on Smear Layer- and Debris-Removal Efficiency After WaveOne Gold® Single File.

Background: An endodontic treatment consists in cleaning, shaping and filling the root canal system. Irrigation is the chemical part of the process that ensures the total removal of debris. Activating the irrigation solution will improve and accelerate the process. Objective: The aim of the study is to evaluate the removal of debris and smear layer at 1, 3, and 5mm from the foramen after needle irrigation, EndoActivator® and Irrisafe®. Sixty single-rooted teeth were prepared using Primary WaveOne Gold®. Methods: Teeth were randomly assigned to 4 groups (n=15): needle irrigation - Group A, EndoActivator® for 1 min - Group B, Irrisafe® for 1 min - Group C, Irrisafe® for 30 sec - Group D. Root canals were observed under a scanning electron microscope. Data were analyzed by Friedman and Wilcoxon tests. Results: Debris was significantly higher with group A compared to B, C, and D. Irrisafe® was significantly more effective in removing the smear layer than the other groups. However, activation techniques showed less debris and smear layer than needle alone nevertheless. Conclusion: Irrisafe® showed the best results regardless of time.

Color Stability of Resin Cements after Water Aging.

The color stability of resin cements plays a key role in the achievement of esthetically-pleasant restorations. Resin luting materials can be mainly divided into two main classes: adhesive (relying on previous application of adhesive systems) or self-adhesive (also known as one-step cements). The different chemical compositions determine their physio-mechanical characteristics which, in turns, influence their color stability. To evaluate the color variations of different dual-cured resin cements after water aging, 80 disc-shaped specimens (15 mm in diameter and 1.2 mm thick) were obtained from the following resin cements (n = 10): (1) Maxcem Elite Universal, MCU (Kerr); (2) RelyX Universal, RXU (3M); (3) Calibra Ceram, CAL (Dentsply); (4) Multilink, MUL (Ivoclar-Vivadent); (5) Panavia V5, PAN (Kuraray); (6) Calibra Universal, CUN (Dentsply); (7) SpeedCEM Plus, SCP (Ivoclar); and (8) Panavia SA, PSA (Kuraray). After light-polymerization, the specimens were measured with a spectrophotometer and CIELab* values were recorded. The specimens were then placed in a digitally controlled thermostatic water bath at 60° for 30 days and afterwards the color measurements were repeated. Color differences were calculated for each specimen before and after water-aging procedures with ΔEab formula and the data were statistically analyzed (p < 0.05). The type of cement statistically influenced the ΔEab (p < 0.05), with MCU showing the lowest color variations (4.3 ± 0.7) whereas RXU and PSA the highest (16.9 ± 1.6 and 16.8 ± 1.2, respectively). No differences were observed between CAL, CUN and SCP (p = 0.05). Color stability is related to the chemical composition of the resinous luting materials, thus material dependent.

A three-year randomized clinical trial evaluating direct posterior composite restorations placed with three self-etch adhesives.

AIM: To compare the clinical performance of composite restorations placed with a universal adhesive, one-step and two-step self-etch adhesives in class I and II posterior cavities. MATERIALS AND METHODS: In this in vivo study, 46 volunteers presenting with at least three carious lesions were included. Each participant received the three restorative systems: universal adhesive/nanofilled composite (Scotchbond Universal/Filtek Z350 XT: SBU/FZXT), one-step self-etch adhesive/microhybrid composite (G-aenial bond/G-aenial Posterior: GB/GP) and the two-step self-etch adhesive/nanohybrid composite (OptiBond XTR/Herculite Ultra: OBX/HU). The adhesives were all placed in self-etch mode. In total, 138 restorations were evaluated at baseline and at 6,12 and 36 months using the modified United States Public Health Service criteria. Data were analysed using Kruskal-Wallis, Mann-Whitney U, Friedman and Wilcoxon non-parametric tests (p < .05). Ninety-one restorations were evaluated at 36 months. RESULTS: Seven restorations, three SBU/FZXT, three GB/GP and one OBX/HU failed during this study. The reasons for failure were marginal fracture and secondary caries. SBU/FZXT restorations showed significant marginal deterioration in all parameters. Overall success rates were: 93.5% (SBU/FZXT), 96.6% (GB/GP) and 96.8% (OBX/HU). CONCLUSIONS: After three years, the three restorative systems have comparable clinical effectiveness and success rates, except for the marginal integrity, that was suboptimal for both the SBU/FZXT and GB/GP restorations in comparison to the OBX/HU restorations.

Dysregulation of Rho GTPases in orofacial cleft patients-derived primary cells leads to impaired cell migration, a potential cause of cleft/lip palate development.

Cleft lip and/or palate are a split in the lip, the palate or both. This results from the inability of lip buds and palatal shelves to properly migrate and assemble during embryogenesis. By extracting primary cells from a cleft patient, we aimed at offering a better understanding of the signaling mechanisms and interacting molecules involved in the lip and palate formation and fusion. With Rho GTPases being indirectly associated with cleft occurrence, we investigated the role of the latter in both. First, whole exome sequencing was conducted in a patient with cleft lip and palate. Primary fibroblastic cells originating from the upper right gingiva region were extracted and distinct cellular populations from two individuals were obtained: a control with no cleft phenotype and a patient with a cleft lip and palate. The genetic data showed three candidate variables in ARHGEF18, EPDR1, and CUL7. Next, the molecular data showed no significant change in proliferation rates between healthy patient cells and CL/P patient cells. However, CL/P patient cells showed decreased migration, increased adhesion and presented with a more elongated phenotype. Additionally, RhoA activity was upregulated in these cells, whereas Cdc42 activity was downregulated, resulting in loss of polarity. Our results are suggestive of a possible correlation between a dysregulation of Rho GTPases and the observed phenotype of cleft lip and palate patient cells. This insight into the intramolecular aspect of this disorder helps link the genetic defect with the observed phenotype and offers a possible mechanism by which CL/P occurs.

Altered regulation of cell migration in IRF6-mutated orofacial cleft patients-derived primary cells reveals a novel role of Rho GTPases in cleft/lip palate development.

Orofacial clefts are the most common congenital craniofacial birth defects. They occur from a failure in cell proliferation and fusion of neural crest cells of the lip buds and/or palatal shelves. In this study, we investigate the genetic basis and molecular mechanisms in primary cells derived from a cleft and lip palate patient presenting van der Woude syndrome (VWS). Since mutations in the integrin genes are widely correlated with VWS, Interferon Regulatory Factor 6 (IRF6) screening was conducted in a cohort of 200 participants presenting with orofacial anomalies. Primary fibroblastic cells derived from the upper right gingiva and palatal regions were isolated and two cellular populations from two participants were obtained: a control with no cleft phenotype and a patient with a cleft phenotype typical of van der Woude syndrome (VWS). IRF6 targeted sequencing revealed mutations in two distinct families. Our results showed no alteration in the viability of the CLP/VWS patient cells, suggesting the phenotype associate with the disease is not secondary to a defect in cell proliferation. We did however detect a significant decrease in the migratory ability of the CLP with Van der Woude syndrome (CLP/VWS) patient cells, which could account for the phenotype. When compared to normal cells, patient cells showed a lack of polarization, which would account for their lack of mobility. Patient cells showed protrusions all around the cells and a lack of defined leading edge. This was reflected with actin staining, WAVE2 and Arp2 around the cell, and correlated with an increase in Rac1 activation. Consistently with the increase in Rac1 activation, patient cells showed a loss in the maturation of focal adhesions needed for contractility, which also accounts for the lack in cell migration. Our findings give increased understanding of the molecular mechanisms of VWS and expands the knowledge of van der Woude syndrome (VWS) occurrence by providing a strong molecular evidence that CLP with Van der Woude syndrome (CLP/VWS) phenotype is caused by a defect in normal physiological processes of cells.

Osteogenic potential of dental and oral derived stem cells in bone tissue engineering among animal models: An update.

Small bone defects can heal spontaneously through the bone modeling process due to their physiological environmental conditions. The bone modeling cycle preserves the reliability of the skeleton through the well-adjusted activities of its fundamental cell. Stem cells are a source of pluripotent cells with a capacity to differentiate into any tissue in the existence of a suitable medium. The concept of bone engineering is based on stem cells that can differentiate into bone cells. Mesenchymal stromal cells have been evaluated in bone tissue engineering due to their capacity to differentiate in osteoblasts. They can be isolated from bone marrow and from several adults oral and dental tissues such as permanent or deciduous teeth dental pulp, periodontal ligament, apical dental papilla, dental follicle precursor cells usually isolated from the follicle surrounding the third molar, gingival tissue, periosteum-derived cells, dental alveolar socket, and maxillary sinus Schneiderian membrane-derived cells. Therefore, a suitable animal model is a crucial step, as preclinical trials, to study the outcomes of mesenchymal cells on the healing of bone defects. We will discuss, through this paper, the use of mesenchymal stem cells obtained from several oral tissues mixed with different types of scaffolds tested in different animal models for bone tissue engineering. We will explore and link the comparisons between human and animal models and emphasized the factors that we need to take into consideration when choosing animals. The pig is considered as the animal of choice when testing large size and multiple defects for bone tissue engineering.

Comparing the osteogenic potential of schneiderian membrane and dental pulp mesenchymal stem cells: an in vitro study.

Mesenchymal stem cells, being characterized by high self-renewal capacity and multi-lineage differentiation potential, are widely used in regenerative medicine especially for repair of bone defects in patients with poor bone regenerative capacity. In this study, we aimed to compare the osteogenic potential of human maxillary schneiderian sinus membrane (hMSSM)-derived stem cells versus permanent teeth dental pulp stem cells (DPSCs). Both cells types were cultivated in osteogenic and non-osteogenic inductive media. Alkaline phosphatase (ALP) activity assay and quantitative real-time PCR analysis were carried out to assess osteogenic differentiation. We showed that ALP activity and osteoblastic markers transcription levels were more striking in hMSSM-derived stem cells than DPSCs. Our results highlight hMSSM-derived stem cells as a recommended stem cell type for usage during bone tissue regenerative therapy.

Differences in osteogenic and odontogenic differentiation potential of DPSCs and SHED.

OBJECTIVE: Dental pulp stem cells (DPSCs) and stem cells from human exfoliated deciduous teeth (SHED) are types of human dental tissue-derived mesenchymal stem cells (MSCs) that have emerged as an interesting and promising source of stem cells in the field of tissue engineering. The aim of this work is to isolate stem cells from DPSCs and SHED, cultivate them in vitro and compare their odontogenic differentiation potential. METHODS: DPSCs and SHED were extracted from molars, premolars and canines of six healthy subjects aged 5-29 years. The cells were characterized, using flow cytometry, for mesenchymal stem cell surface markers. MTT colorimetric assay was applied to assess cell viability. Alizarin red staining, alkaline phosphatase (ALP) activity, quantitative real-time PCR (qRT-PCR) and western blot were carried out to determine DPSCs and SHED osteogenic/odontogenic differentiation. RESULTS: DPSCs express higher STRO-1 and CD44 levels compared to SHED. Moreover, the cells differentiate and acquire columnar shape with a level of calcium deposition and mineralization that is the same between DPSCs and SHED. ALP activity, ALP, COLI, DMP-1, DSPP, OC, and RUNX2 (osteogenic/odontogenic differentiation markers) expression levels were higher in DPSCs. CONCLUSIONS: DPSCs and SHED express MSCs markers. Although both cell types had calcium deposits, DPSCs presented a higher ALP activity level. In addition, DPSCs showed higher levels of osteogenic and odontogenic differentiation markers such as COLI, DSPP, OC, RUNX2, and DMP-1. These results suggest that DPSCs are closer to the phenotype of odontoblasts than SHED and may improve the efficacy of human dental tissue-derived mesenchymal stem cells therapeutic protocols. 'CLINICAL SIGNIFICANCE': DPSCs are closer than t SHED to the phenotype of odontoblasts. This would be helpful to enable better therapeutic decisions when applying MSCs-based therapy in the field of dentistry.

Assessing Dental Light-curing Units' Output Using Radiometers: A Narrative Review.

INTRODUCTION: This review aimed to describe dental radiometers and discuss their effectiveness compared to other light-testing devices. MATERIALS AND METHODS: The search for light-curing units (LCUs), radiometers, and other light-measuring tools available on the market was accomplished on data found on PubMed, Wikipedia, and Google. RESULTS: LCUs are prone to deterioration due to several reasons such as the light's limited life span, the worsening of the LCU's filters, light guide, and light tip end; consequently, decreased photopolymerization and insufficient resin conversion may occur. A regular light output assessment is highly recommended in dental daily practice as well as before any new LCU purchase to make sure the light features meet the factory specifications delivered by the manufacturer and they remained stable through time. DISCUSSION: Irradiance values reported by radiometers do not match accurately with those delivered by laboratory power meters. Therefore, dental practitioners as well as dental students are advised to control regularly every LCU by using the same handheld radiometer.

Scanning electron microscopy evaluation of debris and smear layer generated by two instruments used in reciprocating motion WaveOne Gold® and Reciproc Blue®.

The aim was to evaluate debris and smear layer at 1, 3 and 5 mm from the foramen of single-file systems WaveOne Gold® and Reciproc Blue®. Thirty single-rooted teeth were prepared using one of the following NiTi instruments WaveOne Gold® and Reciproc Blue®. Root canals were observed under a scanning electron microscope. The presence of debris and smear layer at the apical third of root canals was evaluated. Data were analysed by Friedman and Wilcoxon tests. WaveOne Gold® produced significantly less debris and smear layer compared to Reciproc Blue®. However, the mean amount of debris was significantly different within distances for WaveOne Gold®, while no difference were observed for Reciproc Blue. The mean amount of smear layer was not significantly different within distances with WaveOne Gold® and Reciproc Blue®. Both systems showed debris and smear layer in the apical third; nevertheless, WaveOne Gold® showed better results.

Four-Year Follow-up of Increased Vertical Dimension of Occlusion using Resin Composites.

The objectives of this case report were to treat a severe loss of the vertical dimension of occlusion with indirect composite and to evaluate the durability of the restorations. A 55-year-old male complains from severe wear of teeth, leading to a change in normal occlusal plane. Two major treatment modalities were proposed to this patient; a conventional invasive crown placement with root canal treatments or a minimally invasive approach relying on adhesion. The latter was adopted and used to treat this patient. This paper describes a step-by-step approach of the different treatment phases starting with teeth preparation, then provisional prostheses, and ending with the placement of indirect anterior veneers and posterior onlays, all made with laboratory resin composite. Satisfactory clinical results were observed over the 4-year follow-up, with minimum failures limited to one partial fracture of inlay treated with direct adhesive repair.

The Effect of Expiration Date on Mechanical Properties of Resin Composites.

OBJECTIVE: The aim of this in vitro study is to evaluate the effect of expiration date on some mechanical properties of resin composites after controlled storage of syringes and compules in a refrigerator at 4°C. MATERIALS AND METHODS: Specimens were tested at 7 days after storage in distilled water at room temperature. The investigated properties are the static modulus of elasticity, the flexural strength, and the Vickers microhardness. Same batches of restorative materials were examined at baseline (at least 1 year before their expiration date) and 1 year after they expired. RESULTS: Paired t-test is used to compare the results between the two groups using StatView software (version 5.0) SAS Campus Drive Cary, North Carolina, USA. Except for the flexural strength, no statistical differences were found between the mechanical properties of the expired and the unexpired group. CONCLUSION: The 1-year expiry date did not seem to affect the investigated mechanical properties.

Frequently Asked Questions about Vital Tooth Whitening.

Improving patients' aesthetics is an important request in daily practice. Tooth whitening is a treatment option available for improving aesthetics. This paper will pose questions asked by our patients on bleaching techniques and outcomes and offer appropriate up-to-date answers. Clinical relevance: This paper addresses the most important questions raised by patients and colleagues concerning vital tooth whitening (VTW).

Fracturas vertebrales morfométricas y su relación con 25 OH vitamina D, índice de masa corporal y edad en mujeres seniles / Morphometric vertebral fractures and their relationship with 25 OH-vitamin D, body mass index, and age in elderly women

Objetivo: Determinar la presencia de fracturas vertebrales morfométricas y su relación con 25 OH vitamina D, índice de masa corporal y edad en mujeres seniles. Materiales y métodos: Estudio transversal. Se analizaron 319 mujeres seniles, provenientes del estudio "Salud osteomuscular del anciano". La determinación de fracturas vertebrales morfométricas se realizó de manera radiográfica, en tanto que los niveles de 25 OH vitamina D se midieron por inmunoanálisis por quimioluminiscencia (CLIA) Liaison* 25 OH vitamina D Total Assay Ref 310600, utilizando el equipo Diasorin Liaison* Analyzer. El índice de masa corporal se obtuvo, según las recomendaciones de la Organización Mundial de la Salud, como el peso en kilogramos sobre la talla en metros al cuadrado; la edad fue verificada con el documento de identidad y el ingreso del mismo a las bases de datos nacionales (SISPRO-FOSYGA). Resultados: El promedio de edad fue de 74,3 arios (DE ± 7,2). La prevalencia global de fracturas fue de 17,9%; así mismo, el 54,9% de las participantes tenía valores entre 20 y 29ng/ml de 25 OH vitamina D y el 58,9% tenía valores de índice de masa corporal inferior a 25 kg/m². El promedio de 25 OH vitamina D fue inferior en las participantes fracturadas (19,7 vs. 25,1) (p<0,05); el índice de masa corporal también fue menor en las fracturadas (23,5 vs. 24,6) (p>0,05), pero la edad fue mayor: 78,9 vs. 73,4 (p<0,05). Al comparar los promedios de 25 OH vitamina D en participantes fracturadas y no fracturadas, se encontraron niveles significativamente menores de 25 OH vitamina D en las participantes con fractura mayores de 69 años, y al considerar el índice de masa corporal, los valores de 25 OH vitamina D fueron significativamente inferiores en cada una de las categorías de las participantes con fractura. Conclusión: Se encontró una relación estadísticamente significativa entre poseer fracturas vertebrales morfométricas y tener: 1) niveles bajos de 25 OH vitamina D, 2) mayor edad, y 3) menor índice de masa corporal.

Objective: To determine the presence of morphometric vertebral fractures, as well as their relationship with 25 OH vitamin D, body mass index, and age in elderly women. Materials and methods: A cross-sectional study was conducted on 319 elderly women from the study 'Musculoskeletal Health in the Elderly'. The morphometric determination of vertebral fractures was performed with radiography, while the levels of 25 OH vitamin D were determined by the chemiluminescent immunoassay (CLIA) method using the Liaison® 25 OH Vitamin D Total Assay 25 (Ref 310 600), using the Liaison® Analyser. The body mass index was obtained as recommended by the World Health Organisation; weight in kilograms over height in metres squared. The age of the participants was verified by their identity card, and their income details from the national data bases (SISPRO-FOSYGA). Results: The mean age was 74.3 years (SD ± 7.2). The overall prevalence of fractures was 17.9%; 54.9% of participants had values between 20 and 29ng/ml 25 OH vitamin D, and 58.9% had body mass index values less than 25 kg/m². The mean 25 OH vitamin D was lower in participants with fractures (19.7 vs. 25.1) (P < .05). Body mass index was also lower in those with fractures (23.5 vs. 24.6) (P < .05), but age was higher: 78.9 vs. 73.4 (P < .05). When comparing the mean levels of 25 OH vitamin D in fractured and non-fractured participants, significantly lower levels of 25 OH vitamin D were found in participants with fractures over 69 years-old, and on comparing the body mass index, the values of 25 OH vitamin D were significantly lower in each of the categories of participants with a fracture. Conclusion: A statistically significant relationship was found between morphometric vertebral fractures and: 1) low levels of 25 OH vitamin D, 2) being older and, and 3) a lower body mass index.

Frequently asked questions in direct pulp capping of permanent teeth.

UNLABELLED: Direct pulp capping is a proven method of preserving tooth vitality of a mature permanent tooth in cases of pulp exposures. The indications for this treatment, treatment modalities and materials are discussed in this paper. CLINICAL RELEVANCE: This paper answers many of the frequently asked questions by general practitioners, dental students and specialists about direct pulp capping.

Physico-mechanical characteristics of commercially available bulk-fill composites.

OBJECTIVES: Bulk-fill composites have emerged, arguably, as a new "class" of resin-based composites, which are claimed to enable restoration in thick layers, up to 4mm. The objective of this work was to compare, under optimal curing conditions, the physico-mechanical properties of most currently available bulk-fill composites to those of two conventional composite materials chosen as references, one highly filled and one flowable "nano-hybrid" composite. METHODS: Tetric EvoCeram Bulk Fill (Ivoclar-Vivadent), Venus Bulk Fill (Heraeus-Kulzer), SDR (Dentsply), X-tra Fil (VOCO), X-tra Base (VOCO), Sonic Fill (Kerr), Filtek Bulk Fill (3M-Espe), Xenius (GC) were compared to the two reference materials. The materials were light-cured for 40s in a 2mm×2mm×25mm Teflon mould. Degree of conversion was measured by Raman spectroscopy, Elastic modulus and flexural strength were evaluated by three point bending, surface hardness using Vickers microindentation before and after 24h ethanol storage, and filler weight content by thermogravimetric analysis. The ratio of surface hardness before and after ethanol storage was considered as an evaluation of polymer softening. Data were analyzed by one-way ANOVA and post hoc Tukey's test (p=0.05). RESULTS: The mechanical properties of the bulk-fill composites were mostly lower compared with the conventional high viscosity material, and, at best, comparable to the conventional flowable composite. Linear correlations of the mechanical properties investigated were poor with degree of conversion (0.090.8). Softening in ethanol revealed differences in polymer network density between material types. CONCLUSION: The reduction of time and improvement of convenience associated with bulk-fill materials is a clear advantage of this particular material class. However, a compromise with mechanical properties compared with more conventional commercially-available nano-hybrid materials was demonstrated by the present work. SIGNIFICANCE: Given the lower mechanical properties of most bulk-fill materials compared to a highly filled nano-hybrid composite, their use for restorations under high occlusal load is subject to caution. Further, the swelling behaviour of some of the bulk-fill materials may be a reason for concern, which highlights the critical requirement for a veneering material, not only to improve aesthetic quality of the translucent material, but to reduce the impact of degradation.

A 5-year comparison of marginal bone level following immediate loading of single-tooth implants placed in healed alveolar ridges and extraction sockets in the maxilla.

PURPOSE: The aim of present investigation was to evaluate marginal bone level after 5-year follow-up of implants placed in healed ridges and fresh extraction sockets in maxilla with immediate loading protocol. MATERIALS AND METHODS: Thirty-six patients in need of a single-tooth replacement in the anterior maxilla received 42 Astra Tech implants (Astra Tech Implant system™, Dentsply Implants, Mölndal, Sweden). Implants were placed either in healed ridges (group I) or immediately into fresh extraction sockets (group II). Implants were restored and placed into functional loading immediately by using a prefabricated abutment. Marginal bone level relative to the implant reference point was recorded at implant placement, crown cementation, 12, 36, and 60 months following loading using intra-oral radiographs. Measurements were made on the mesial and distal sides of each implant. RESULTS: Overall, two implants were lost from the group II, before final crown cementation: they were excluded from the study. The mean change in marginal bone loss (MBL) after implant placement was 0.26 ± 0.161 mm for 1 year, and 0.26 ± 0.171 mm for 3 years, and 0.21 ± 0.185 mm for 5 years in extraction sockets and was 0.26 ± 0.176 mm for 1 year and 0.21 ± 0.175 mm for 3 years, and 0.19 ± 0.172 mm for 5 years in healed ridges group. Significant reduction of marginal bone was more pronounced in implants inserted in healed ridges (P < 0.041) compared to fresh surgical extraction sockets (P < 0.540). Significant MBL was observed on the mesial side of the implant after cementation of the provisional (P < 0.007) and after 12 months (P < 0.034) compared to the distal side which remained stable for 3 and 5 years observation period. CONCLUSIONS: Within the limitations of this study, responses of local bone to immediately loaded implants placed either in extraction sockets or healed ridges were similar. Functional loading technique by using prefabricated abutment placed during the surgery time seems to maintain marginal bone around implant in both healed and fresh extraction sites.

Frequently asked questions in composite restorative dentistry.

UNLABELLED: With an increasing number of dental practitioners using composite resins as the restorative material of choice, knowledge of terminology, handling properties and restorative techniques are important. CLINICAL RELEVANCE: This paper addresses many of the questions raised by participants at lectures and courses given by the authors across Europe.

[Multidisciplinary approach to behavior control of children during dental care: clinical study on the effect of learning by imitation]. / Approche multidisciplinaire du contrôle du comportement de l'enfant durant les soins médico-dentaires: étude clinique sur l'effet de la technique d'apprentissage par imitation.

Many techniques of behavioral control of children have been developed to help the good performance of their health treatment. The objective of this study was to test the effect of the "modeling" technique on the pulse of the children during dental treatment. 69 girls and 86 boys were selected and divided into 3 groups A, B and C. Groups A and B were approached using the "modeling" technique and by taking respectively the mother or the father as a model. For the group C, the 'tell show do' approach was only used. The pulses of these children were registered during the check-up session and the cleaning therapy that followed. The results showed statistical significance (p < 0.001) of the two major factors investigated: gender of the children and choice of the model when using the modeling technique.