See Also : Ozone Therapy (
Index ) // Ozone
In Dentistry ( I )
http://www.thesleuthjournal.com
http://www.newagegathering.com/ozonated-olive-oil-promotes-oral-health/
Ozonated
Olive Oil Promotes Oral Health
by Dr. Edward F. Group III
The use of oxygen in complementary therapies has been gaining
momentum in recent years, particularly in the area of dentistry.
While ozonated olive oil has many practical and effective uses,
such as supporting skin health, research has shown it to be
especially helpful for periodontal disease. Gingivitis,
typically caused by diets laden with sugar and refined
carbohydrates, is a growing issue today. One recent study is
revealing just how powerful ozonated therapy can be in the area
of teeth and gum health. If you’re currently suffering from any
type of dental issue, you may want to continue reading.
Olive Oil:
A Potential Complementary Periodontitis Approach
Ozone therapy isn’t an entirely new concept in dentistry.
Previous research and medical reviews have discussed the
importance of ozone in replacing antiseptic agents used against
gingival infections. [1] A study published in Tanta Dental
Journal evaluated 30 subjects with periodontal disease, each
receiving standard periodontitis treatments. [2] Half of the
group was subjected to both standard treatments and ozonated
therapy. These patients received ozonated olive oil gel applied
to the main site of gum damage.
The group that received the complementary therapy in addition to
conventional treatment saw longer lasting improvements in
symptoms. As a matter of fact, the ozonated therapy combined
with root scaling resulted in sustained improvements for up to
six months, while the benefits from the standard treatment alone
only lasted about a month. Although the size of the study
participants is relatively small, it is one study among dozens
that indicate the effectiveness of ozone therapy in
complementing standard medical applications.
Using
Ozonated Olive Oil
One of the main uses for ozonated olive oil is in the area of
skin health. Ozonated olive oil contains antibacterial compounds
that may support the skin’s defense against bacteria and other
compounds that cause acne. Olive oil itself is also an excellent
moisturizer, providing a nourishing smoothness to the skin. Many
people also brush their teeth with ozonated olive oil in
addition to fluoride-free toothpaste to get a deep clean.
References:
Huth KC, Jakob FM, Saugel B, et al. Effect of ozone on oral
cells compared with established antimicrobials. Eur J Oral Sci.
2006 Oct;114(5):435.
M.Y.M. Shoukheba, Sh.A. Ali. The effects of subgingival
application of ozonated olive oil get in patient with localized
aggressive periodontitis. A clinical and bacteriological study.
Tanta Dental Journal. Volume 11, Issue 1, April 2014, Pages
63-73.
Dr. Edward F. Group III, DC, NP, DACBN, DCBCN, DABFM has studied
natural healing methods for over 20 years and now teaches
individuals and practitioners all around the world. He no longer
sees patients but solely concentrates on spreading the word of
health and wellness to the global community. Under his
leadership, Global Healing Center, Inc. has earned recognition
as one of the largest alternative, natural and organic health
resources on the Internet.
http://www.ncbi.nlm.nih.gov/pubmed/17026511
Eur J Oral Sci. 2006 Oct;114(5):435-40.
Effect
of ozone on oral cells compared with established
antimicrobials.
Huth KC,
Jakob FM, Saugel B, Cappello C, Paschos E, Hollweck R,
Hickel R, Brand K.
Abstract
Ozone has been proposed as an alternative antiseptic agent in
dentistry based on reports of its antimicrobial effects in both
gaseous and aqueous forms. This study investigated whether
gaseous ozone (4 x 10(6) microg m(-3)) and aqueous ozone
(1.25-20 microg ml(-1)) exert any cytotoxic effects on human
oral epithelial (BHY) cells and gingival fibroblast (HGF-1)
cells compared with established antiseptics [chlorhexidine
digluconate (CHX) 2%, 0.2%; sodium hypochlorite (NaOCl) 5.25%,
2.25%; hydrogen peroxide (H(2)O(2)) 3%], over a time of 1 min,
and compared with the antibiotic, metronidazole, over 24 h. Cell
counts, metabolic activity, Sp-1 binding, actin levels, and
apoptosis were evaluated. Ozone gas was found to have toxic
effects on both cell types. Essentially no cytotoxic signs were
observed for aqueous ozone. CHX (2%, 0.2%) was highly toxic to
BHY cells, and slightly (2%) and non-toxic (0.2%) to HGF-1
cells. NaOCl and H(2)O(2) resulted in markedly reduced cell
viability (BHY, HGF-1), whereas metronidazole displayed mild
toxicity only to BHY cells. Taken together, aqueous ozone
revealed the highest level of biocompatibility of the tested
antiseptics.
http://www.ncbi.nlm.nih.gov/pubmed/25512726
Eur J Dent. 2014 Oct;8(4):469-74. doi:
10.4103/1305-7456.143627.
Antimicrobial
effect of ozonated water, sodium hypochlorite and
chlorhexidine gluconate in primary molar root canals.
Goztas Z,
Onat H, Tosun G, Sener Y, Hadimli HH.
Abstract
OBJECTIVE:
The aim was to determine the antimicrobial effect of ozonated
water, ozonated water with ultrasonication, sodium hypochloride
and chlorhexidine (CHX) in human primary root canals
contaminated by Enterococcus faecalis (E. faecalis).
MATERIALS
AND METHODS:
Fifty-eight extracted human primary molar teeth were used.
Crowns were cut off using a diamond saw under water-cooling. One
hundred roots were obtained and mechanically prepared. The roots
were then sterilized by autoclaving in water for 15 min at
121°C. All samples were contaminated with E. faecalis for 24 h
and the root canals were randomly divided into five groups (n =
20). Group I: 25 mg/L of Ozonated water (O3aq), Group II: 25
mg/L of O3aq with ultrasonication, Group III: 2.5% Sodium
hypochloride (NaOCl), Group IV: 2% CHX and Group V: Positive
control. The canal of each specimen was irrigated for 4 min and
positive control was untreated. All root canals were agitated
with sterile saline solution. The saline solution was collected
from canals with sterile paper points. For each specimen, the
paper points were transposed to eppendorf vials containing 2 ml
of brain heart infusion. According to bacterial proliferation,
the mean values of optical density were achieved by ELISA
(Biotek EL ×800, Absorbance Microplate Reader, ABD) and the data
were analyzed.
RESULTS:
NaOCI, CHX and two types of O3aq were found statistically
different than positive control group. NaOCI irrigation was
found significantly most effective.
CONCLUSIONS:
NaOCl, CHX and O3aq applications provide antibacterial effect in
vitro conditions in primary root canals.
http://www.ncbi.nlm.nih.gov/pubmed/25368798
J Microbiol. 2014 Jul;7(7):e11411. doi:
10.5812/jjm.11411. Epub 2014 Jul 1.
Antibacterial
Efficacy of Aqueous Ozone in Root Canals Infected by
Enterococcus faecalis.
Hubbezoglu
I, Zan R, Tunc T, Sumer Z.
Abstract
BACKGROUND:
In endodontics, the elimination of resistant bacteria such as
Enterococcus faecalis plays an important role for treatment
success in root canals. Therefore, new alternative irrigants
(instead of sodium hypochlorite) have been researched to achieve
ideal endodontic treatment.
OBJECTIVES:
The aim of the present study was to evaluate and to compare the
antibacterial effect of aqueous ozone with different
concentrations and techniques of application (manual and
ultrasonic) against E. faecalis in human root canals.
PATIENTS
AND METHODS:
Eighty single-root mandibular premolar teeth were selected,
prepared and sterilized. E. faecalis was incubated in the root
canals and kept at 37°C for 24 h. The teeth were divided into
four main groups each has 20 members: NaOCl (positive control)
group; 8 ppm aqueous ozone group; 12 ppm aqueous ozone group;
and 16 ppm aqueous ozone group. While half of the specimens were
disinfected with aqueous ozone by manual technique, the other
half was disinfected with the aqueous ozone by ultrasonic
technique. Conventional irrigation technique was simultaneously
applied with ultrasonic vibration that was produced by VDW.ULTRA
device. The disinfection procedures were performed for 180 s to
ensure standardization of all the working groups. Paper points
(placed in the root canals before and after the disinfection
procedures) were transferred to Eppendorf tubes containing 0.5
mL of brain heart infusion broth. Then, 50 µL of the suspension
was inoculated onto broth agar media. Microbial colonies were
counted, and the data were evaluated statistically using 2-way
analysis of variance (ANOVA) and Tukey tests.
RESULTS:
Although the antibacterial effect of 16 ppm aqueous ozone using
a manual technique had an insufficient effect, its ultrasonic
application technique resulted in complete disinfection in the
root canals.
CONCLUSIONS:
The bactericidal activity of high concentration of aqueous ozone
combined with ultrasonic application technique showed efficacy
similar to that of 5.25% NaOCl in root canals.
http://www.ncbi.nlm.nih.gov/pubmed/25363268
Interv Neuroradiol. 2014 Oct 31;20(5):632-6. doi:
10.15274/INR-2014-10083. Epub 2014 Oct 17.
Ozone
therapy in dentistry. A brief review for physicians.
Domb WC
Abstract
The 21(st) century dental practice is quite dynamic. New
treatment protocols and new materials are being developed at a
rapid pace. Ozone dental therapy falls into the category of new
treatment protocols in dentistry, yet ozone is not new at all.
Ozone therapy is already a major treatment modality in Europe,
South America and a number of other countries. What is provided
here will not be an exhaustive scientific treatise so much as a
brief general introduction into what dentists are now doing with
ozone therapies and the numerous oral/systemic links that make
this subject so important for physicians so that, ultimately,
they may serve their patients more effectively and productively.
http://www.ncbi.nlm.nih.gov/pubmed/25221698
Ann Med Health Sci Res. 2014 Jul;4(4):526-31.
doi: 10.4103/2141-9248.139301.
Qualitative
analyses of the antimicrobial effect of ozonated water on
supragingival plaque and salivary microbes.
Sadatullah
S, Mohamed N, Razak F.
Abstract
BACKGROUND:
Ozone is an unstable gas, capable of oxidizing any biological
entity. It is an effective bactericide in its gaseous as well as
aqueous form.
AIMS:
The objective of this study was to determine the in-situ
antimicrobial effect of 0.1 ppm ozonated water on plaque and
salivary microorganisms.
SUBJECTS
AND METHODS:
24 h old supragingival plaque (SP) was collected from the two
most posterior teeth in the contralateral quadrants before and
after a 30 s rinse with either distilled water (control group)
or 0.1 ppm ozonated water (test group). Simultaneously
stimulated whole saliva (SWS) was collected for both groups. The
SP and SWS were stained with LIVE/DEAD Baclight Bacteria
Viability fluorescent kit to visualize live and dead microbes.
The salivary flow rate, calcium and protein level were also
determined in the pre- and post-rinsed samples. The data
obtained was subjected to One Way ANOVA test using Minitab 14
statistical software (PA, USA).
RESULTS:
0.1 ppm ozonated water was found effective in reducing the
bacterial load in both the 24 h plaque and SWS samples, but it
did not eliminate them completely. In addition, there was no
statistically significant effect of the ozonated water rinse on
the salivary flow rate, salivary calcium and protein
concentration.
CONCLUSIONS:
0.1 ppm ozonated water rinse can be an effective adjunct to
tooth brushing and flossing to maintain plaque and salivary
bacterial load.
http://www.ncbi.nlm.nih.gov/pubmed/22574088
J Med Life. 2012 Feb 22;5(1):59-67. Epub 2012 Mar 5.
Ozone
therapy in periodontics.
Gupta G,
Mansi B.
Abstract
Gingival and Periodontal diseases represent a major concern both
in dentistry and medicine. The majority of the contributing
factors and causes in the etiology of these diseases are reduced
or treated with ozone in all its application forms (gas, water,
oil). The beneficial biological effects of ozone, its
anti-microbial activity, oxidation of bio-molecules precursors
and microbial toxins implicated in periodontal diseases and its
healing and tissue regeneration properties, make the use of
ozone well indicated in all stages of gingival and periodontal
diseases. The primary objective of this article is to provide a
general review about the clinical applications of ozone in
periodontics. The secondary objective is to summarize the
available in vitro and in vivo studies in Periodontics in which
ozone has been used. This objective would be of importance to
future researchers in terms of what has been tried and what the
potentials are for the clinical application of ozone in
Periodontics.
http://www.ncbi.nlm.nih.gov/pubmed/24324309
J Int Oral Health. 2013 Oct;5(5):79-84. Epub 2013 Oct 26.
Effect
of Ozonised water on Chronic Periodontitis - A Clinical
Study.
Katti
SS1, Chava VK.
Abstract
BACKGROUND:
The aim of the study was to study the clinical effects of
ozonated water on periodontal tissues.
MATERIALS
& METHODS:
In the present study 30 subjects were selected with age ranging
from 20 to 60 yearsand pocket depth of =5mm. Two sites were
selected in each patient whichwere divided into two groups.
Group 1(control group-irrigation with saline) and Group 2(study
group-irrigation with ozonized water) and clinical parameters
were recorded at baseline, 15 days and 30 days.
RESULTS:
When the comparison of mean values of Plaque Index and Gingival
Index between the groups and at different time intervals were
made, statistically significant difference were observed at 30
days at 5% level. When the mean values of clinical attachment
level on mesial and distal site was compared between the groups,
statistical significance was observed at 5% level and 1% level
respectively.Similarly statistical significance at 5% level was
observed at 15 and 30 days on buccal site.
CONCLUSION:
Subgingival irrigation with ozonized water is beneficial adjunct
treatment modality to enhance periodontal health with
significant role in periodontal therapy. How to cite this
article: Katti SS, Chava VK. Effect of Ozonised water on Chronic
Periodontitis - A Clinical Study. J Int Oral Health
2013;5(5):79-84.
http://www.ncbi.nlm.nih.gov/pubmed/23946585
J Pharm Bioallied Sci. 2013 Jun;5(Suppl 1):S89-94. doi:
10.4103/0975-7406.113304.
Application
of ozone in the treatment of periodontal disease.
Srikanth
A, Sathish M, Sri Harsha AV.
Abstract
Gingivitis and periodontitis are most common inflammatory
diseases of supporting tissues of teeth. Role of microbial
etiology and host response in progression of gingival and
periodontal diseases has been well established. Because of the
beneficial biological effects of ozone, due to its antimicrobial
and immunostimulating effect, it is well indicated in the
treatment of gingival and periodontal diseases. The objective of
this article is to provide a general review about clinical
applications of ozone in treatment of periodontal diseases and
to summarize the available in vitro and in vivo studies in
Periodontics in which ozone has been used.
http://www.ncbi.nlm.nih.gov/pubmed/16393498
Prim Dent Care. 2006 Jan;13(1):37-41.
The
use of ozone in dentistry and medicine. Part 2. Ozone and
root caries.
Baysan A,
Lynch E.
Abstract
A previous paper, recently published in Primary Dental Care,
gave an overview of the medical uses of ozone and outlined some
of its uses in dentistry. The current paper focuses on a
description of use of ozone in the management of root caries and
considers recent studies in this area. There has been relatively
limited research into the non-invasive (pharmaceutical)
management of root caries. The best management strategy still
remains to be developed. Initial studies have indicated that an
application of ozone for a period of either 10 or 20 seconds is
capable of clinically reversing leathery root carious lesions.
It is suggested that, subject to confirmation from extensive
trials, this simple and non-invasive technique may benefit many
patients with root caries throughout the world since this
approach to treat root caries can easily be employed in primary
care clinics and in the domiciliary treatment of home-bound
elderly people and immobile patients in hospices and hospitals.
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3662033/
Iran Endod J. 2013 Spring; 8(2): 40–43.
http://www.ncbi.nlm.nih.gov/pubmed/23717326
A Review
of the Properties and Applications of Ozone in Endodontics:
An Update
Zahed
Mohammadi, Sousan Shalavi, Mohammad Karim Soltani, and Saeed
Asgary
Abstract
Ozone is a triatomic molecule consisting of three oxygen atoms.
It is applied to oral tissues in the forms of ozonated water,
ozonated olive oil and oxygen/ozone gas. This paper presents a
brief review on the chemistry of ozone as well as its medical
and dental applications focusing on its use in endodontics.
Ozone’s antimicrobial activity, its effect on dentin bonding,
toxicity and contra-indications are also reviewed.
Keywords: Antimicrobial, Dentin Bonding, Endodontics, Ozone,
Toxicity
1.Introduction
In 1839, Christian F. Schonbein, first noticed the emergence of
a pungent gas with an electric smell. Later, in 1857, Wener Von
Siemens designed an ozone generator. Oxygen/ozone therapy has a
long history of research and clinical and therapeutic
applications on humans. The first medical application was in
1870 when Lender purified blood in test tubes. Medical
applications became widespread throughout Europe and America. As
of 1929, more than 114 diseases were listed for treatment with
oxygen/ozone. In 1930, Fisch, used ozone on a regular basis in
his dental practice in Switzerland (1).
2.Chemistry
of ozone
Ozone (O3) is a triatomic molecule with three oxygen atoms and
molecular weight of 47.98 g/mol. Thermodynamically, this
molecule is a highly instable compound that decomposes to pure
oxygen with a short half-life in particular temperature and
pressure conditions (2). Ozone is 1.6-fold denser and 10-fold
more soluble in water (49 mL in 100 mL water at 0°C) than
oxygen. Although ozone is not a radical molecule, it is the
third most potent oxidant after fluorine and per sulfate. Ozone
is an unstable gas that cannot be stored and should be used at
once because it has a half-life of 40 min at 20°C (2). Ozone is
naturally produced by the photo dissociation of molecular oxygen
(O2) into activated oxygen atoms, which then react with further
oxygen molecules. This transient radical anion rapidly becomes
protonated, generating hydrogen trioxide (HO3), which, in turn,
decomposes to an even more powerful oxidant, the hydroxyl
radical (OH) (3). It is the fundamental form of oxygen that
occurs naturally as a result of ultraviolet energy or lightning,
causing a temporary recombination of oxygen atoms into groups of
three. In the clinical setting, an oxygen/ozone generator
simulates lightning via an electrical discharge field. Ozone gas
has a high oxidation potential and is 1.5 times more effective
than chloride when used as an antimicrobial agent against
bacteria, viruses, fungi, and protozoa. It also has the capacity
to stimulate blood circulation and the immune response. Ozone
has been indicated for the treatment of 260 different
pathologies (4, 5).
3.Routes of
ozone therapy
Ozone is applied to oral tissues in the following forms:
Ozonated water, ozonated olive oil, and oxygen/ozone gas.
Ozonated water and olive oil have the capacity to entrap and
then release oxygen/ozone; an ideal delivery system. These forms
of application are used individually or in combination to treat
dental disease (6).
4.Applications
of ozone in medicine
Most of our knowledge is based on multiple case reports from
hospitals and clinics. Ozone can enhance both lung function and
inflammatory airway responses to inhale allergen in cases with
pre-existing allergic airway diseases (7).
Medicated forms of O3 in a gaseous form are somewhat unusual,
and that is why special application techniques have had to be
developed for the safe use of ozone. In other words, due to the
difficulty in handling and administering gaseous ozone, some
methods and devices have been introduced to enhance its
effectiveness. In local applications such as the treatment of
external wounds, transcutaneous O3 gas bath has been established
as a most practical and useful method; at low (subatmospheric)
pressure in a closed system guaranteeing no escape of ozone into
the ambient air. Ozonized water, whose use is particularly known
in dental medicine, is optimally applied as a spray or in
compressed form (8).
Apart from rectal insufflation which is principally used for the
treatment of intestinal conditions, and also applied
systemically, autohemotherapy has established itself as a
systemic therapy of choice. A corresponding dosage of ozone gas
is transferred (in the form of microbubbles) into 50 to 100 ml
of the patient’s blood in a sealed, pressure-less system, thus
achieving the finest possible distribution to reach the greatest
possible number of red and white blood cells to activate their
metabolism. This is a markedly low-risk method when hygiene
guidelines are observed, disposable units are used, and the
material used is ozone-resistant. In the therapy of pain in the
locomotor system, ozone can be applied supportively in the form
of intramuscular or intra-articular injections (2).
5.Ozone in
dentistry
Muller et al. (9) compared the influence of ozone gas with
photodynamic therapy (PDT) and known antiseptic agents (2%
Chlorhexidine, 0.5 and 5% sodium hypochlorite solutions) on a
multispecies oral biofilm in-vitro. The studied bacteria were
Actinomyces naeslundii, Veillonella dispar, Fusobacterium
nucleatum, Streptococcus (S.) sobrinus, S. oralis and Candida
(C.) albicans. Gasiform ozone was produced by vacuum ozone
delivery system Kavo HealOzone (Biberach, Germany). They
concluded that the matrix-embedded microbial populations in
biofilm are well protected against antimicrobial agents. Only 5%
NaOCl solution was able to eliminate all bacteria effectively.
Gasiform ozone or PDT was not able to significantly reduce or
completely eliminate bacteria in the biofilm (9). Baysan et al.
assessed antimicrobial effect of Kavo HealOzone device on
primary root caries lesions (PRCL) and evaluated the efficiency
of ozone specifically on S. mutans and S. sobrinus (10). As a
result, ozone exposure to either 10 or 20 s under experimental
conditions reduced the total levels of microorganisms in the
PRCLs to <1% of the control values. Application of ozone for
a period of 10 s was also capable of reducing the numbers of S.
mutans and S. sobrinus in-vitro (10). Holmes (11) observed the
effect of KaVo Healozone device on PRCL followed by
professionally-applied remineralizing solution containing
xylitol, fluoride, calcium, phosphate and zinc. This treatment
modality was applied to 89 patients over 60. After 18 months
100% of ozone-treated primary root caries lesions (PRCLs) had
improved. In control group, where lesions were left without
treatment, only one PRCL had improved. In 62% of cases the
status remained leathery, while in 37% of PCRL’s had worsened
from leathery to soft texture (11).
The influence of ozonated water on the epithelial wound healing
process in the oral cavity was observed by Filippi (12). It was
found that ozonized water applied on a daily basis can
accelerate the healing rate in oral mucosa. This effect was seen
in the first two postoperative days. Daily treatment with
ozonized water accelerates the physiological healing rate in the
treated wounds as such changes were not seen in the untreated
wounds (12).
6.Ozone in
endodontics
Ozone gas in a ~4 g/m3 concentration (HealOzone; KaVo, Biberach,
Germany) is used clinically for endodontic treatments.
6.1.Antimicrobial
activity
Most studies on the applications of ozone in endodontics focus
on its antimicrobial activity. Nagayoshi et al. (13) found that
ozonated water (0.5–4 mg/L) was highly effective in killing both
gram positive and negative micro-organisms. Gram negative
bacteria, such as Porphyromonas (P.) endodontalis and P.
gingivalis were substantially more sensitive to ozonated water
than gram positive oral streptococci and C. albicans in pure
culture. Hems et al. (14) evaluated the potential of ozone as an
antibacterial agent using Enterococcus (E.) faecalis as a test
species. Ozone was used both as gasiform (produced by Pure zone
device), and aqueous (optimal concentration 0.68 mg/L). They
concluded that ozone in solution was antibacterial against
planktonic E. faecalis after 240 s treatment. However it was not
effective against E. faecalis within a biofilm unless they were
displaced into the surrounding medium by agitation (14).
Estrela et al. (15) studied antimicrobial effects of ozonated
water, gaseous ozone and antiseptic agents (2.5% hypochlorite
and 2% chlorhexidine) in infected human dental root canals. Over
the 20 min contact time none of these substances had
antibacterial effect against E. faecalis in the infected root
canals.
Thanomsub et al. (16) tested the effects of ozone treatment on
cell growth and ultrastructural changes in bacteria (Escherichia
coli, Salmonella sp., Staphylococcus aureus and Bacillus
subtilis). It was discovered that ozone at 0.167 mg/min/L
concentration can be used to sterilize water, which is
contaminated within 30 min with up to 105 cfu/ml bacteria.
Destroying of bacterial cell membrane was observed, subsequently
producing intercellular leakage and eventually causing cell
lysis. Nevertheless, these ozone concentrations have no
significant effect on the cell viability of bacterial cultures
at higher concentrations of 106 and 107 CFU/mL (16).
Polydorou et al. (17) found that 80 s as well as 40s
applications of ozone was effective in eliminating S. mutans. In
an animal study on the infected dog's teeth, Silveira et al.
(2007) showed 77% root canal treatment success rate when using
ozonized oil as an intra-canal medicament. A further study
evaluated the effectiveness of ozonated water in the elimination
of C. albicans, E. faecalis, and endotoxins from root canals
(18). Findings revealed that ozonated water was effective
against both C. albicans and E. faecalis immediately after
treatment; however it did not have substantivity. Furthermore,
ozonated water demonstrated no anti-endotoxin activity. The
disinfecting effect of ozonized oxygen (120 s from the
HealOzone) on E. faecalis has been assessed (19). Findings
revealed that ozonized oxygen appears to be suitable for
disinfecting root canal systems in cases where sodium
hypochlorite is not indicated. Huth et al. (20) assessed the
effectiveness of aqueous and gaseous ozone against E. faecalis,
C. albicans, Peptostreptococcus micros and Pseudomonas
aeruginosa cultured in planktonic media or in mono-species
biofilms. Results demonstrated that high-concentrated gaseous
and aqueous ozone was dose-, strain- and time-dependently
effective against the tested microorganisms. The antibacterial
activity of gaseous ozone was shown to be greater than KTP laser
and less than NaOCl (21) and ozone gas delivered into irrigating
fluids in the root canal may be useful as an adjunct for
endodontic disinfection (22).
7.Effects
on dentin bonding
Schmidlin et al. (23) evaluated the influence of direct
high-dose gaseous ozone application (2100 ppm) on dentin and
enamel shear bond strength; despite a possible retention of
surface and subsurface oxide-related substances during high-dose
ozone application, the strength was not impaired. Thus, adhesive
restoration placement should be possible immediately after ozone
application for cavity disinfection. However, other researchers
reported that adhesion of the self-adhesive resin cement RelyX
Unicem (3M ESPE, Seefeld, Germany) was significantly reduced
after using gaseous ozone (24).
Magni et al. (25) indicated that Ozone gas did not compromise
the mechanical properties of the adhesives [including Prime
& Bond NT (Dentsply), Excite (Ivoclar-Vivadent),
Syntac/Heliobond (Ivoclar-Vivadent) and Silorane System Adhesive
(3 M-ESPE)]. When ozone gas was used to disinfect the cavity
before a restoration, it had no influence on immediate enamel
and dentin bond strength (26). Çehreli et al. (27) revealed that
pre-treatment with ozone improved the marginal sealing ability
of the fissure sealants; another study demonstrated that ozone
therapy improved shear bond strength of AH-26 and EX Fill root
canal sealers (28). Gurgan et al. (29) showed that ozone
treatment did not impaired the shear bond strength of two
self-etch adhesives (Clearfil SE Bond and Clearfil Tri-S Bond)
used on coronal and radicular dentin. However other studies
showed that ozone decreased the microtensile bond strength of
dentin-composite resin interface (30) and reduced the initial
microtensile bond strength of Clearfil SE Bond (31). According
to Arslan et al. (32) ozone did not significantly affect the
dentin bond strength of a silorane-based resin composite, filtek
supreme. Also, another study revealed that ozone gas and
ozonated water had no deleterious effects on the bond strengths
and interfaces (33).
8.Toxicity
Ozone inhalation can be toxic to the pulmonary system and other
organs. Complications caused by ozone therapy are infrequent at
0.0007 per application. Known side-effects are epiphora, upper
respiratory irritation, rhinitis, cough, headache, occasional
nausea, vomiting, shortness of breath, blood vessel swelling,
poor circulation, heart problems and even stroke. Because of
ozone's high oxidative power, all materials that come in contact
with the gas must be ozone resistant, such as glass, silicon,
and Teflon. However, in the event of ozone intoxication, the
patient must be placed in the supine position and treated with
vitamin E and N-acetylcysteine (2).
9.Contra-indications
of ozone therapy
The following conditions mentioned in the medical literatures
contraindicate ozone use e.g. acute alcohol intoxication, recent
myocardial infarction, hemorrhage in any organ, pregnancy,
hyperthyroidism, thrombocytopenia and ozone allergy (2-4).
10.Conclusion
Ozone is applied to oral tissues in various forms: ozonated
water, ozonated olive oil, and oxygen/ozone gas. Ozone has been
used in medicine extensively. In dentistry, its effectiveness on
wound healing, antibacterial activity, and its effect on dentin
bonding has been investigated. Ozone improves wound healing,
assists in treating root caries and can be used against
endodontic microbiota. Furthermore, it seems that ozone does not
have significant adverse effect on dentin bonding. In spite of
infrequency of side effects, ozone therapy may cause serious
medical complications if incorrectly used. Therefore care must
be taken when handling ozone.
References
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3307081/
J Med Life. 2012 Feb 22; 5(1): 59–67. 2012 Mar 5.
PMCID: PMC3307081
Ozone
therapy in periodontics
G Gupta
and B Mansi
Abstract
Gingival and Periodontal diseases represent a major concern both
in dentistry and medicine. The majority of the contributing
factors and causes in the etiology of these diseases are reduced
or treated with ozone in all its application forms (gas, water,
oil). The beneficial biological effects of ozone, its
anti-microbial activity, oxidation of bio-molecules precursors
and microbial toxins implicated in periodontal diseases and its
healing and tissue regeneration properties, make the use of
ozone well indicated in all stages of gingival and periodontal
diseases. The primary objective of this article is to provide a
general review about the clinical applications of ozone in
periodontics. The secondary objective is to summarize the
available in vitro and in vivo studies in Periodontics in which
ozone has been used. This objective would be of importance to
future researchers in terms of what has been tried and what the
potentials are for the clinical application of ozone in
Periodontics.
Introduction
The word ozone comes from the Greek “ozein” meaning odorant.
Ozone (also known as triatomic oxygen and trioxygen) is an
allotropic form of oxygen occurring naturally in the Earth’s
atmosphere. It surrounds the Earth at an altitude of between
50,000 and 100,000 feet. [1] It is created in nature when
ultraviolet rays cause oxygen atoms to temporarily recombine in
groups of three. It is also formed by the action of electrical
discharges on oxygen, so it is often created by thunder and
lightning.
It has got the capacity to absorb the harmful ultra-violet rays
present in the light spectrum from the Sun. It is a pale blue
gas that condenses to a deep blue liquid at very low
temperatures.
Ozone is an unstable gas and it quickly gives up nascent Oxygen
molecule to form Oxygen gas. Due to the property of releasing
nascent Oxygen, it has been used in human medicine since long
back to kill bacteria, fungi, to inactivate viruses and to
control hemorrhages. [2] Medical grade ozone is made from pure
medical oxygen. It is produced commercially in ozone generators,
which involves sending an electrical discharge through a
specially-built condenser containing oxygen.
History
First discovered until 1840 by the German chemist Christian
Frederick Schonbein at the University of Basil in Switzerland,
ozone was first used in medicine in 1870 by Landler. However, it
was not until 1932 that ozone was seriously studied by the
scientific community, when ozonated water was used as a
disinfectant by Dr. E. A. Fisch, [3] a Swiss dentist. Fisch had
the first idea to use ozone as either a gas or ozonated water in
his practice. By a twist of fate, a surgeon, Dr. E Payr
(1871–1946) had to be treated for a gangrenous pulpite and
remained astonished by the result achieved with local ozone
treatment. He enthusiastically extended its application to
general surgery.
At the time, ozone therapy was difficult and limited due to the
lack of ozone-resistant materials, such as Nylon, Dacron, and
Teflon, until 1950 when ozone-resistant materials were
manufactured. At that time Joachim Hänsler, a German physicist
and physician, joined another German physician, Hans Wolff, to
develop the first ozone generator for medical use. Their design
continues to be the basis for modern equipment.
Ozone
generators
There are three different systems for generating ozone gas: [4]
• Ultraviolet System: produces low concentrations of ozone, used
in esthetics, saunas, and for air purification.
• Cold Plasma System: used in air and water purification.
• Corona Discharge System: produces high concentrations of
ozone. It is the most common system used in the medical/ dental
field. It is easy to handle and it has a controlled ozone
production rate.
Medical grade ozone is a mixture of pure oxygen and pure ozone
in the ratio of 0.05% to 5% of 3 and 95% to 99.95% of O2. Due to
the instability of the 3 molecule, medical grade ozone must be
prepared immediately before use. Within less than an hour after
preparation only half of the mixture is still ozone while the
other half is transformed into oxygen. As a result, it is
impossible to store ozone over long periods of time. In order to
control the decomposition of 3 into oxygen it can be associated
with a vehicle with aqueous properties to promote the conversion
more quickly or with a vehicle with more viscous properties to
retard the conversion.
Use of
ozone in dentistry
The use of ozone in dentistry is gaining its place in every
day's dental practice and is used in almost all dental
applications. The undisputed disinfection power of ozone over
other antiseptics makes the use of ozone in dentistry a very
good alternative and/or an additional disinfectant to standard
antiseptics.
Due to safety concerns, 3 gas was not recommended for intra-oral
use. Only dissolved ozone in water and ozonated oils were and
are still commonly used in different fields of dentistry. With
the development of a foot pedal-activated dental handpiece with
a suction feature, 3 gas can now be used safely in situations
where diffusion is an important factor, i.e. dental hard
tissues.
According to German dentist Fritz Kramer, [5] ozone, such as in
the form of ozonated water, can be used in the following ways.
1. as a powerful disinfectant
2. in its ability to control bleeding
3. in its ability to cleanse wounds in bones and soft tissues.
4. by increasing the local supply of oxygen to the wound area,
ozone can improve healing.
5. ozonated water can increase temperature in the area of the
wound, and this increase the metabolic processes related to
wound healing.
Dr. Kramer points out that ozonated water can be used in a
number of different ways:
1. as a mouth rinse (especially in cases of gingivitis,
paradentosis, thrush or stomatitis);
2. as a spray to cleanse the affected area, and to disinfect
oral mucosa, cavities and in general dental surgery;
3. as an ozone/water jet to clean cavities of teeth being
capped, receiving root canal therapy, and in treating painful
gingivitis and stomatitis.
Biological
actions
The application of ozone in dentistry comes as a result of
physico-chemical properties: There are several known actions of
ozone on human body, such as immunostimulating and analgesic,
antihypoxic and detoxicating, antimicrobial, bioenergetic and
biosynthetic (activation of the metabolism of carbohydrates,
proteins, lipids) etc. [6]
1. Antimicrobial effect- Ozone works destructively against
bacteria, fungi, and viruses. The antimicrobial effect of ozone
is a result of its action on cells by damaging its cytoplasmic
membrane due to ozonolysis of dual bonds and also ozone-induced
modification of intracellular contents (oxidation of proteins
loss of organelle function) because of secondary oxidants
effects. This action is non-specific and selective to microbial
cells; it does not damage human body cells because of their
major antioxidative ability. Ozone is very efficient in
antibiotics resistant strains. Its antimicrobial activity
increases in liquid environment of the acidic pH. In viral
infections the ozone action lies in the intolerance of infected
cells to peroxides and change of activity of reverse
transcriptase, which takes part in synthesis of viral proteins.
[6] Being a very strong oxidant it joins with biomolecules
containing cysterine, cysteine, methionine, histidine (all being
part of bacterial cell membranes. The main targets of their
attack are the thiol groups of the amino acid cysteine. As a
result of the reaction of ozone with unsaturated fatty acids of
a lipid sheath of a virus the lipid sheath of a virus melts. The
research shows that a few-second-application of ozone stops all
vital functions of bacteria which are incapable of developing
any self-immunity to its action. Gram+ (Gram-positive) bacteria
are more sensitive to the action of ozone than Gram–
(Gram-negative) bacteria. Oxygen-free bacteria react to ozone as
well. Among cariogenic bacteria Streptococcus mutans and
Streptococcus sobrinus are the most sensitive. Ozone easily acts
on multi unsaturated fatty acids which occur in virus sheaths.
Ozone reacts also with ascorbinians and tocopherols. [7]
2. Immunostimulating Effect- Ozone influences cellular and
humoral immune system. It stimulates proliferation of
immunocompetent cells and synthesis of immunoglobulins. It also
activates function of macrophages and increases sensitivity of
micro-organisms to phagocytosis. [6] As a response to this
activation through ozone, the body's immune cells produce
special messengers called cytokines. These molecules in turn
activate other immune cells, setting off a cascade of positive
change throughout the immune system, which is stimulated to
resist diseases. This means that the application of medical
ozone is extremely useful for immune activation in patients with
a low immune status and/or immune deficit. [8] Ozone causes the
synthesis of biologically active substances such as
interleukins, leukotrienes and prostaglandins which is
beneficial in reducing inflammation and wound healing. [6] Ozone
in high concentration causes immunodepressive effect whereas in
its low concentration immunostimulating effect. [7]
3. Antihypoxic effect- Ozone brings about the rise of pO2 in
tissues and improves transportation of oxygen in blood, which
results in change of cellular metabolism – activation of aerobic
processes (glycolysis, Krebs cycle, ß-oxidation of fatty acids)
and use of energetic resources. Repeating low doses of ozone
activate enzymes: super-oxide dismutases, catalases,
dehydrogenase, and glutatione peroxidases. They are part of
complex enzymatic systems which protect organisms against the
action of oxygen-free radicals. It also prevents formation of
erythrocytes aggregates and increases their contact surface for
oxygen transportation. Its ability to stimulate the circulation
is used in the treatment of circulatory disorders and makes it
valuable in the revitalizing organic functions. [6] Ozone
improves the metabolism of inflamed tissues by increasing their
oxygenation and reducing local inflammatory processes. By
changing the cell membrane structure of erythrocytes and causing
the increase of its negative charge it influences the structure
change as well as blood cell elasticity. This in consequence
reduces blood cell rolling and enables blood flow in capillary
vessels. By increasing the concentration of 2,3
Diphosphoglycerate (2,3-DPG), ozone changes the configuration of
erythrocytes, which enables them to return oxygen in the
inflamed tissue. [7]
4. Biosynthetic Effect- It activates mechanisms of protein
synthesis, increases amount of ribosomes and mitochondria in
cells. These changes on the cellular level explain elevation of
functional activity and regeneration potential of tissues and
organs. [6]
5. Ozone causes secretion of vasodilators such as NO, which is
responsible for dilatation of arterioles and venules. [6] It
also activates angiogenesis. [7]
6. Ozone, when acting on the organic substance of mineralized
tooth tissues intensifies their remineralization potential. At
the same time, it is capable of “opening” dentinal tubules,
which enables the diffusion of calcium and phosphorus ions to
the deeper layers of carious cavities. [9]
A high concentration of ozone kills bacteria very quickly and is
thousand times more powerful than other bacterial killing
agents. The average concentration of ozone used in treatments is
25 gm of ozone per milliliter of oxygen/ozone gas mixture that
translates into 0.25 parts of ozone to 99.75 parts of oxygen.
Evidence-based research has shown that at this concentration,
ozone effectively kills bacteria, fungi, viruses and parasites.
[10] As an antimicrobial agent, it is a powerful oxidizer at a
dramatically lower concentration than chlorine with none of the
toxic side effects. One molecule of ozone is equal to between
3,000 to 10,000 molecules of chlorine and it kills pathogenic
organisms 3,500 times faster. [10] Studies have revealed that it
only takes 10 sec to kill 99 % of bacteria, fungi and viruses.
[11] It can oxidize many organic compounds and it is a powerful
germicide. [12] Some of the other effects are circulatory
enhancement, disruption of tumor metabolism and stimulation of
oxygen metabolism. [13]
According to most authors, a 10-sec-application of ozone causes
the destruction of 99% of bacteria, and a 20-sec-application
even of 99.9%. In this way, so-called ecological niche appears.
However, it is not conducive to their repeated colonization
within 4 to 6 weeks. [14,15] Ozone is not toxic when it is given
in the amount of 0.05 ppm for 8 hours. During ozone therapy a
maximum concentration of ozone in oral cavity amounts to 0.01
ppm.
Goals of
ozone therapy
Setting the standard-of-care and therapeutic goals are based on
sound evidence-based science is critical. Therapeutic goals are
inclusive and not exclusive of standard of care. The goals of
oxygen/ozone therapy are: [10]
1. Elimination of pathogens.
2. Restoration of proper oxygen metabolism.
3. Induction of a friendly ecologic environment.
4. Increased circulation.
5. Immune activation.
6. Simulation of the humoral anti-oxidant system.
Use in
dentistry
Periodontology- Gingivitis, Periodontits, Periimplantitis,
Surgical cuts, Prophylaxis
Dental and oral pathology- Caries, Enamel cracks, Root canal
treatment, Tooth whitening, Dentinal hypersensitivity, Abscess,
Granuloma, Fistulae, Apthae, Herpes infection, Stomatitis –
Candidiasis
Surgery- Implantation, Re-plantation, Extraction, Wound Healing,
Coaguloapathy - prolonged bleeding
Prosthodontics and restorative dentistry- Stumps and crown
disinfection, Cavity disinfection
Orthodontics and orthopedics- TMJ dysfunctions, Trismus,
Relaxation, Myoarthtopathy
Diagnostics- Vitality test
Appliances
producing ozone for dental use
1. HealOzone by KaVo is air-based and the application of the gas
takes place in a closed circuit. Its surplus is sucked out and
neutralized by manganese ions. The concentration of ozone in the
cap adjacent to the tissue amounts to 2100 ppm. Perfect air
tightness of the cap is necessary for the application of ozone.
Therefore, the application is only possible on the surfaces
where such air tightness can be provided.
2. OzonyTron by MYMED Gmb H. - Oxygen activation generator
(OzonytronX—Biozonix, München, Germany) uses the power of high
frequency and voltage. Activated oxygen (ozone) concentration
can be adjusted in 5 levels via current strength. Inside the
glass probe, which is formed by a double glass camera, is a
noble gasses mixture that is conducting and emitting
electromagnetic energy. When the tip of the probe gets in
contact with the body it emits energy around the treated area
and splits environmental diatomic oxygen in singular atomic
oxygen and ozone. The concentration of ozone in the operation
field is 10 to 100 µg/ml (becomes a fungi-, viru-, and
bacteriocide at the intensity of 1–5 µg/ml). There is no closed
circuit here, therefore, ozone can be applied to the places that
are difficult to reach, e.g. gingival pockets or root canals.
3. Product photo (Prozone) by W&H - It is characterized by
its ease of use and safety of application (preset
tissue-compatible dosages in the indication areas of
periodontitis and endodontitis). Prozone ensures a hygienic
procedure during the gassing of the pockets due to its
exchangeable plastic attachments (Perio tips or Endo tips).
Route of
ozone administration
1. Gaseous Ozone - Gaseous ozone is most frequently used in
restorative dentistry and endodontics. Topical administration of
the gaseous form can be via an open system or via a sealing
suction system as a prerequisite to avoid inhalation and adverse
effects. Ozone appears to be an integral part of noninvasive
therapy of dental caries, as a disinfectant prior to placing a
direct restoration and as therapy for hypomineralized teeth.
[16]
2. Ozonated Water - Ozonated water has been shown to be very
effective against bacteria, fungi and viruses and is also less
expensive compared to other chemical cleaners. [17] Gaseous
ozone was shown to be a more effective microbicide than the
aqueous form and, applied for 3 min, may be used as a dental
disinfectant. [18] Because ozone gas has been found to have
toxic effects if inhaled into the respiratory tract, [16,18,19]
ozonated water may be useful to control oral infections and
various pathogens.[15]
3. Ozonized Oil - In addition to ozone application in its
gaseous and aqueous form, sunflower ozonized oil also seems
extremely convenient. The wide accessibility of sunflower oil
makes it a competitive antimicrobial agent. Ozonized oil
(Oleozone, Bioperoxoil) has shown to be effective against
Staphylococci, Streptococci, Enterococci, Pseudomonas,
Escherichia coli and especially Mycobacteria [16,20,21] and has
been utilized for the cure of fungal infections. [16,20]
Ozone
therapy in periodontics
The main use of ozone in dentistry relies on its antimicrobial
properties. It is proved to be effective against both Gram
positive and Gram negative bacteria, viruses and fungi. [22]
Ebensberger et al [23] evaluated the effect of irrigation with
ozonated water on the proliferation of cells in the periodontal
ligament adhering to the root surfaces of 23 freshly extracted
completely erupted third molars. The teeth were randomly treated
by intensive irrigation with ozonated water for 2 min or
irrigation with a sterile isotonic saline solution, serving as a
control group. The periodontal cells of these teeth were studied
immunohistochemically to mark proliferating cell nuclear antigen
(PCNA). It was observed that the labeling index (the number of
positive cells compared to the total number of cells suggesting
enhancement of metabolism) was higher among the teeth irrigated
with ozone (7.8% vs. 6.6%); however, the difference was not
statistically significant (p = 0.24). They concluded that the 2
min irrigation of the avulsed teeth with non-isotonic ozonated
water might lead not only to a mechanical cleansing, but also
decontaminate the root surface, with no negative effect on
periodontal cells remaining on the tooth surface.
Nagayoshi et al [24] examined the effect of ozonated water on
oral microorganisms and dental plaque. Dental plaque samples
were treated with 4mL of ozonated water for 10 s. they observed
that ozonated water was effective for killing gram-positive and
gram-negative oral microorganisms and oral Candida albicans in
pure culture as well as bacteria in plaque biofilm and therefore
might be useful to control oral infectious microorganisms in
dental plaque.
Nagayoshi et al [17] tested the efficacy of three different
concentrations of ozone water (0.5, 2, and 4 mg/ml in distilled
water) on the time-dependent inactivation of cariogenic,
periodontopathogenic and endodontopathogenic microbes
(Streptococcus, Porphyromonas gingivalis and endodontalis,
Actinomyces actinomycetemcomitans, Candida albicans) in culture
and in biofilms. They confirm that ozonated water was highly
effective in killing of both gram positive and gram negative
micro-organisms.
Depending on the dosage, the oral microbes were inactivated
after 10 seconds. Gram negative anaerobes, such as Porphyromonas
endodontalis and Porphyromonas gingivalis were substantially
more sensitive to ozonated water than gram positive oral
streptococci and Candida albicans in pure culture. Furthermore
ozonated water had strong bactericidal activity against bacteria
in plaque biofilm. In addition, ozonated water inhibited the
accumulation of experimental dental plaque in vitro.
Ramzy et al [24] irrigated the periodontal pockets by ozonized
water in 22 patients suffering from aggressive periodontitis
(age range from 13 to 25 years). Periodontal pockets were
irrigated with 150 ml of ozonized water over 5 to 10 minutes
once weekly, for a clinical four weeks study, using a blunt
tipped sterile plastic syringe. High significant improvement
regarding pocket depth, plaque index, gingival index and
bacterial count was recorded related to quadrants treated by
scaling and root planning together with ozone application. They
also reported significant reduction in bacterial count in sites
treated with ozonized water.
Huth et al [19] in their study declared that the aqueous form of
ozone, as a potential antiseptic agent, showed less cytotoxicity
than gaseous ozone or established antimicrobials (chlorhexidine
digluconate-CHX 2%, 0.2%; sodium hypochlorite-NaOCl 5.25%,
2.25%; hydrogen peroxide-H2O2 3%) under most conditions.
Therefore, aqueous ozone fulfils optimal cell biological
characteristics in terms of biocompatibility for oral
application.
Huth et al [26] in their later paper examined the effect of
ozone on the influence on the host immune response. These
researchers chose the NF-kappaB system, a paradigm for
inflammation-associated signalling/transcription. Their results
showed that that NF-kappaB activity in oral cells in periodontal
ligament tissue from root surfaces of periodontally damaged
teeth was inhibited following incubation with ozonized medium.
The Huth 2007 study establishes a condition under which aqueous
ozone exerts inhibitory effects on the NF-kappaB system,
suggesting that it has an anti-inflammatory capacity.
Muller et al [27] compared the influence of ozone gas with
photodynamic therapy (PDT) and known antiseptic agents (2%
Chlorhexidine, 0,5 and 5% hypochlorate solutions) on a
multispecies oral biofilm in vitro. The following bacteria were
studied – Actinomyces naeslundii, Veillonella dispar,
Fusobacterium nucleatum, Streptococcus sobrinus, Streptococcus
oralis and Candida albicans. Gasiform ozone was produced by
vacuum ozone delivery system Kavo Healozone. They concluded that
the matrix-embedded microbial populations in biofilm are well
protected towards antimicrobial agents. Only 5 % Hypochlorate
solution was able to eliminate all bacteria effectively. Usage
of gasiform ozone or PDT was not able to reduce significantly or
completely eliminate bacteria in the biofilm.
Kronusová [28] used ozone in following cases: prevention of
dental caries in fissures of the first permanent molars in
children, application of ozone in prepared cavity, after tooth
extraction, in case of postextractional complications, in
patients with chronic gingivitis, periodontitis and periodontal
abscesses, herpes labialis, purulent periodontitis, dentition
difficilis, etc. Almost all patients with gingivitis showed
subjective and objective improvement of their status, as well as
patients with periodontal abscess, where no exsudation was
observed. Application of ozone after tooth extraction was found
also quite useful – only 10 % of patients suffered from such
complication as alveolitis sicca, but even in these cases the
clinical course was shorter and more moderate.
The influence of ozonized water on the epithelial wound healing
process in the oral cavity was observed by Filippi. [29] It was
found that ozonized water applied on the daily basis can
accelerate the healing rate in oral mucosa. This effect can be
seen in the first two postoperative days. The comparison with
wounds without treatment shows that daily treatment with
ozonized water accelerates the physiological healing rate.
In the study by Karapetian et al, [30] periimplantitis treatment
with conventional, surgical and ozone therapy methods was
investigated, and it was found that the most effective bacteria
reduction was in the ozone-treated patient group. The authors
concluded that the main challenge seems to be the
decontamination of the implant surface, its surrounding tissue
and the prevention of recolonization with periodontal pathogenic
bacteria.
Kshitish and Laxman [31] conducted a randomized, double-blind,
crossover split-mouth study on 16 patients suffering from
generalized chronic periodontitis. The study period of 18 days
was divided into two time-intervals, i.e. baseline (0 days) to
7th day, with a washout period of 4 days followed by a second
time interval of 7 days.
Subgingival irrigation of each half of the mouth with either
ozone or chlorhexidine was done at different time intervals.
They observed a higher percentage of reduction in plaque index
(12%), gingival index (29%) and bleeding index (26%) using ozone
irrigation as compared to chlorhexidine. The percentile
reduction of Aa (25%) using ozone was appreciable as compared to
no change in Aa occurrence using chlorhexidine. By using 3 and
chlorhexidine, there was no antibacterial effect on
Porphyromonas gingivalis (Pg) and Tannerella forsythensis. The
antifungal effect of ozone from baseline (37%) to 7th day
(12.5%) was pronounced during the study period, unlike CHX,
which did not demonstrate any antifungal effect. No antiviral
property of ozone was observed. The antiviral efficacy of
chlorhexidine was better than that of ozone. They concluded that
despite the substantivity of chlorhexidine, the single
irrigation of ozone is quite effective to inactivate
microorganisms.
Application
modalities
According to the clinical case, different applications
modalities are available using ozone gas, irrigation with
ozonated water and in-office use of ozonized oil as well as home
use.
Gas application via a customized thermoformed dental appliance-
A customized suckdown thermoformed hard or medium-soft dental
appliance can be prepared. It should extend 2-3 mm beyond the
affected gingival area, leaving a free space for gas
circulation. 2 ports should be attached for the gas inlet and
outlet respectively at the distal and mesial of the treatment
area. The edges of the appliance should be reclined with light
or medium body silicone. Light-cured dam can also be applied as
an extra safety precaution to completely seal the borders. The
ports to the generator and the suction pump should then be
attached. This procedure will treat both hard and soft tissues
of the affected area. PVC or silicone cap can be used to treat
individually all the indicated areas in difficult situations
where such an appliance is hard to use or uncomfortable to the
patient.
Irrigation with Ozonated Water- Ozonated water can be used to
irrigate the affected area during and after scaling, root
surface planning, and non-surgical pocket curettage.
In-office and Home Use of Ozonized Olive Oil- After in-office
treatment with ozone gas or ozonated water, pockets can be
filled with ozonized olive oil using a blunt 25G needle or any
other appropriate tip. Patient can be given some of the oils for
home use. In-office ozonized oil application can be repeated
once a week.
Surgical Procedures- Ozonated water can be used as an irrigant
during the surgical procedure and/or as a final surgical site
lavage. The sutures can be covered with a thin layer of ozonized
oil and the patient can be instructed to apply the oil 3-4 times
a day.
Peri-Implantitis- Peri-implantitis is very bothering to both the
dentist and the patient. After thorough assessment and if a
decision is taken to salvage the case, different modes of
therapy are used in order to save the implant from total loss.
Laser and/or manual debridement along with antiseptic solutions
and topical anti-microbial medicines are commonly performed with
a varying degree of success. Ozone can play an important role
and be used as gas or in aqueous form. An appropriate length of
PVC or silicone cap can be cut to cover the abutment fully. It
should properly seal the gingival borders around the implant.
Ozone gas infiltrations can also be used in this situation.
Ozonated water can be used as an irrigant during debridement and
curettage. Patient can be advised to apply ozonized oil on the
treated area 3-4 times/day.
Desensitization of sensitive root necks [2]
Quick and prompt relief from root sensitivity has been
documented after ozone spray for 60 seconds followed by mineral
wash onto the exposed dentine in a repetitive manner. This
desensitization of dentine lasts for longer period of time.
Smear layer present over the exposed root surface prevents the
penetration of ionic Calcium and Fluorine deep into the dentinal
tubules. Ozone removes this smear layer, opens up the dentinal
tubules, broadens their diameter and then Calcium and Fluoride
ions flow into the tubules easily, deeply and effectively to
plug the dentinal tubules, preventing the fluid exchange through
these tubules. Thus, ozone can effectively terminate the root
sensitivity problem within seconds and also lasts longer than
those by conventional methods.
Ozone
toxicity
Ozone inhalation can be toxic to the pulmonary system and other
organs. Complications caused by ozone therapy are infrequent at
0.0007 per application. Known side-effects are epiphora, upper
respiratory irritation, rhinitis, cough, headache, occasional
nausea, vomiting, shortness of breath, blood vessel swelling,
poor circulation, heart problems and at times stroke. [44]
Because of ozone's high oxidative power, all materials that come
in contact with the gas must be ozone resistant, such as glass,
silicon, and Teflon. However, in the event of ozone intoxication
the patient must be placed in the supine position, and treated
with vitamin E and n-acetylcysteine. [16]
Contraindications
The following are contraindications for use of ozone therapy:
[4]
• Pregnancy
• Glucose-6-phosphate-dehydrogenase deficiency (favism)
• Hyperthyroidism
• Severe anaemia
• Severe myasthenia
• Active hemorrhage
• Acute alcohol intoxication
• Recent Myocardial infarction
Discussion
Gingivitis and periodontitis are characterized by a local
hypoxia of tissues and also by various microbic florae that may
contain over 500 species. Accumulations of bacterial plaque in
the gingival crevice area in an increased amount causes changes
in the oral cavity ecology leading to both gingivitis and
periodontitis. [33]
Dental biofilm makes it difficult for antibiotics in targeting
putative periodontal pathogens. Higher concentrations of
antibiotics are required to kill these organisms which are
inevitably associated with toxic adverse effect on the host
microbial flora. The application of ozone therapy in
periodontics showed promising results. Both gaseous and aqueous
ozone are used as a substitute to mechanical debridement. Ozone
can be used to help treat periodontal disease by using ozonated
water flushed below the gum line and/or ozone gas infiltrated
into the gum tissue and supporting tissues.
Ozonated water (4mg/l) strongly inhibited the formation of
dental plaque and reduced the number of sub gingival pathogens
both gram positive and gram negative organisms. Gram negative
bacteria, such as P. endodontalis and P. gingivalis were
substantially more sensitive to ozonated water than gram
positive oral streptococci and C. albicans in pure culture. [17]
Furthermore ozonated water had strong bactericidal activity
against bacteria in plaque biofilm. In addition, ozonated water
inhibited the accumulation of experimental dental plaque in
vitro. [17]
Dental researchers have started to examine the effects of
ozonated fluids in periodontal disease. Huth et al in two papers
in 2006 [19] and 2007 [26] examined the effect of ozone on
periodontal tissues. The 2007 paper compared traditional
periodontal anti-microbial products with the use of ozonated
water. Both papers concluded that ozonated water has an
excellent anti-microbial effect.
It resulted in toxic effect on human oral epithelial and
fibroblast cells compared to antiseptics such as chlorehexidine
digluconate, sodium hypochlorite and hydrogen peroxide during a
1-minute time period. [34,35] Ozone gas found to be toxic to the
human oral epithelial and gingival fibroblast cells and aqueous
ozone was more biocompatible than gaseous ozone. [19] The
application of ozone therapy in chronic gingival and periodontal
diseases, showed subjective and objective improvement of their
status, as well as patients with periodontal abscess, with no
exudation was observed. [36]
Brauner [37] has demonstrated that the combination of
professional tooth cleaning and daily rinsing of the mouth with
ozone water can improve clinical findings in cases of gingivitis
and periodontitis. Plaque indices and a tendency to bleed,
however, quickly return if the professional measures are
interrupted. Rinsing the mouth with ozone water without any
mechanical procedures for plaque reduction were unsuccessful.
There are many benefits to control oral hygiene and as a source
of sterile water. However, patients should also be informed that
there is an interaction of aqueous ozone with anti-microbials.
This research has been published, illustrating the importance of
potential interactions of dissolved ozone and prescribed
anti-microbials. Patients who are taking a course of antibiotics
may need to be informed that the use of ozonated water
inactivates antibacterial agents [28] and in particular
amoxicillin, [29] progesterone [30] and tetracycline. [31] What
concerns the dentists is that ozone may inactivate the
anti-microbial effects of triclosan. [32]
The effect of ozone on wounds obtained in the process of
surgical and implantological procedures is used to prevent
complications like after-surgical infection and to conduce to
proper tissue healing. The use of ozone around implants is
supported by published research showing that ozone not only
effectively sterilizes the surfaces of both the implant and
bone, but also switches on the reparative mechanisms allowing
tissue regeneration around implant surfaces. [43] According to
Matsumura et al [44,45] ozone does not have a major impact on
stimulation of gingival cells for osteoblastic activity in the
regeneration of the periodontium around implants.
Conclusions
Dentistry is changing as we are now using modern science to
practice dentistry. In comparison with classical medicine
modalities such as antibiotics and disinfectants, ozone therapy
is quite inexpensive, predictable and conservative. The ozone
therapy has been more beneficial than present conventional
therapeutic modalities. This state of the art technology allows
us to take a minimally invasive and conservative approach to
dental treatment. The elucidation of molecular mechanisms of
ozone further benefits practical application in dentistry.
Treating patients with ozone therapy reduces the treatment time
with a great deal of difference and it eliminates the bacterial
count more precisely. The treatment is completely painless and
increases the patients' acceptability and compliance with
minimal adverse effects. Although more clinical research has to
be done to standardize indications and treatment procedures of
ozone therapy, still many different approaches are so promising,
or already established, that hopefully the use of ozone therapy
becomes a standard treatment for disinfection of an operation
sites in dentistry.
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PMCID: PMC3276005
Ozone
therapy in dentistry: A strategic review
Rajiv
Saini
Abstract
The oral cavity appears as an open ecosystem, with a dynamic
balance between the entrance of microorganisms, colonization
modalities, and host defenses aimed to their removal: To avoid
elimination, bacteria need to adhere to either hard dental
surfaces or epithelial surfaces. The oral biofilm formation and
development, and the inside selection of specific microorganisms
have been correlated with the most common oral pathologies, such
as dental caries, periodontal disease, and peri-implantitis. The
mechanical removal of the biofilm and adjunctive use of
antibiotic disinfectants or various antibiotics have been the
conventional methods for periodontal therapy. Ozone (O3) is a
triatomic molecule, consisting of three oxygen atoms, and its
application in medicine and dentistry has been indicated for the
treatment of 260 different pathologies. The ozone therapy has
been more beneficial than present conventional therapeutic
modalities that follow a minimally invasive and conservative
application to dental treatment. The exposition of molecular
mechanisms of ozone further benefits practical function in
dentistry.
http://www.ncbi.nlm.nih.gov/pubmed/18473030
J Contemp Dent Pract. 2008 May 1;9(4):75-84.
Ozone
therapy in medicine and dentistry.
Nogales
CG1 Ferrari PH, Kantorovich EO, Lage-Marques JL.
Abstract
AIM:
The purpose of this review is to present the potential for
the incorporation of ozone therapy into the practice of
dentistry.
BACKGROUND:
Ozone gas has a high oxidation potential and is 1.5 times
greater than chloride when used as an antimicrobial agent
against bacteria, viruses, fungi, and protozoa. It also has the
capacity to stimulate blood circulation and the immune response.
Such features justify the current interest in its application in
medicine and dentistry and have been indicated for the treatment
of 260 different pathologies. It can be used for the treatment
of alveolitis as a replacement for antibiotic therapy, as a
mouthwash for reducing the oral microflora, as well as the
adherence of microorganisms to tooth surfaces. Ozone has been
shown to stimulate remineralization of recent caries-affected
teeth after a period of about six to eight weeks.
CONCLUSION:
The future of ozone therapy must focus on the establishment
of safe and well-defined parameters in accordance with
randomized, controlled trials to determine the precise
indications and guidelines in order to treat various medical and
dental pathologies. Scientific support, as suggested by
demonstrated studies, for ozone therapy presents a potential for
an atraumatic, biologically-based treatment for conditions
encountered in dental practice.
http://www.ncbi.nlm.nih.gov/pubmed/16683682
Quintessence Int. 2006 May;37(5):353-9.
The
use of ozone in dentistry and maxillofacial surgery: a
review.
Stübinger
S, Sader R, Filippi A.
Abstract
Ozone has been successfully used in medicine because of its
microbiologic properties for more than 100 years. Its
bactericide, virucide, and fungicide effects are based on its
strong oxidation effect with the formation of free radicals as
well as its direct destruction of almost all microorganisms. In
addition, ozone has a therapeutic effect that facilitates wound
healing and improves the supply of blood. For medical purposes,
ozone may be applied as a gas or dissolved in water. Despite the
advantages that the therapeutic use of ozone offers,
reservations remain in terms of its application in the oral and
maxillofacial area. Particularly, the gaseous application of
ozone is critically evaluated because of its possible side
effects on the respiratory system. The objective of this article
is to provide an overview of the current applications of ozone
in dentistry and oral surgery. Research was based on
peer-reviewed sources found through a Medline/PubMed search and
other textbooks, reviews, and journals.
http://www.ncbi.nlm.nih.gov/pubmed/19097384
Prague Med Rep. 2008;109(1):5-13.
Ozone
and its usage in general medicine and dentistry. A review
article.
Seidler
V, Linetskiy I, Hubálková H, Stanková H, Smucler R, Mazánek
J.
Abstract
Ozone, an allotropic form of oxygen, is successfully used in
the treatment of different diseases for more than a hundred
years. It is highly valued for various effects, such as
antimicrobial, antihypoxic, analgesic, immunostimulating etc. on
biological systems. These mechanisms of action supported with a
lot of case reports and scientific studies allow using it in
different fields of medicine. This review of literature is
another attempt to summarize different modalities of ozone
application in dentistry. Further studies are necessary to
standardize indications and treatment protocols of this
promising medical agent.
http://www.ncbi.nlm.nih.gov/pubmed/11093025
Caries Res. 2000 Nov-Dec;34(6):498-501.
Antimicrobial
effect of a novel ozone- generating device on
micro-organisms associated with primary root carious lesions
in vitro.
Baysan A,
Whiley RA, Lynch E.
Abstract
The aims of this present study were (1) to assess the
antimicrobial effect of ozone from a novel ozone-generating
device (Heolozone, USA) [0.052% (v/v) in air delivered at a rate
of 13.33 ml.s(-1)] on primary root carious lesions (PRCLs) and
(2) to evaluate the efficacy of ozone specifically on
Streptococcus mutans and Streptococcus sobrinus. In study 1, 40
soft PRCLs from freshly extracted teeth were randomly divided
into two groups to test the antimicrobial effect on PRCLs from
exposure to ozonated water for either 10 or 20 s. Half of a
lesion was removed using a sterile excavator. Subsequently, the
remaining lesion was exposed to the ozonised water for a period
of either 10 or 20 s (corresponding to 0. 069 or 0.138 ml of
ozone, respectively). Using paired Student t tests, a
significant (p<0.001) reduction (mean +/- SE) was observed in
the ozone-treated groups with either a 10-second (log(10)
3.57+/-0.37) or 20-second (log(10) 3.77+/-0.42) ozone
application compared with the control groups (log(10)
5.91+/-0.15 and log(10) 6.18+/-0.21, respectively). In study 2,
40 sterile saliva-coated glass beads were randomly divided into
two groups for each micro-organism. One glass bead was put into
each bijou bottle with 3 ml of Todd-Hewitt broth. S. mutans and
S. sobrinus were inoculated anaerobically overnight. Each glass
bead was then washed with 2 ml of phosphate-buffered saline.
Immediately, 10 s of ozone gas was applied to each glass bead in
the test groups. There was a significant (p<0.0001) reduction
(mean +/- SE) in ozone-treated samples for S. mutans (log(10)
1.01+/-0.27) and S. sobrinus (log(10) 1.09+/-0.36) compared with
the control samples (log(10) 3.93+/-0.07 and log(10)
4.61+/-0.13, respectively). This treatment regime is an
effective, quick, conservative and simple method to kill
micro-organisms in PRCLs. Ozone gas application for a period of
10 s was also capable of reducing the numbers of S. mutans and
S. sobrinus on saliva-coated glass beads in vitro.
http://www.ncbi.nlm.nih.gov/pubmed/14697022
Gerodontology. 2003 Dec;20(2):106-14.
Clinical
reversal of root caries using ozone, double-blind,
randomised, controlled 18-month trial.
Holmes J.
Abstract
OBJECTIVE:
To assess the effect of an ozone delivery system, combined
with the daily use of a remineralising patient kit, on the
clinical severity of non-cavitated leathery primary root carious
lesions (PRCL's), in an older population group.
DESIGN:
A total of 89 subjects, (age range 60-82, mean +/- SD, 70.8
+/- 6 years), each with two leathery PRCL's, were recruited. The
two lesions in each subject were randomly assigned for treatment
with ozone or air, in a double-blind design, in a general dental
practice. Subjects were recalled at three, six, 12 and 18
months. Lesions were clinically recorded at each visit as soft,
leathery or hard, scored with a validated root caries severity
index.
RESULTS:
There were no observed adverse events. After three months,
in the ozone-treated group, 61 PRCL's (69%) had become hard and
none had deteriorated, whilst in the control group, four PRCL's
(4%) had become worse (p<0.01). At the six-month recall, in
the ozone group, seven PRCL's (8%) remained leathery, the
remaining 82 (92%) PRCL's had become hard, whilst in the control
group, 10 PRCL's had become worse (11%) and one had become hard
(p<0.01). At 12 and 18 months, 87 Subjects attended. In the
ozone group at 12 months, two PRCL's remained leathery, compared
to 85 (98%) that had hardened, whilst in the control group 21
(24%) of the PRCL's had progressed from leathery to soft, i.e.
became worse, 65 PRCL's (75%) were still leathery, and one
remained hard (p<0.01). At 18 months, 87 (100%) of
ozone-treated PRCL's had arrested, whilst in the control group,
32 lesions (37%) of the PRCL's had worsened from leathery to
soft (p<0.01), 54 (62%) PRCL's remained leathery and only one
of the control PRCL's had reversed (p<0.01).
CONCLUSIONS:
Leathery non-cavitated primary root caries can be arrested
non-operatively with ozone and remineralising products. This
treatment regime is an effective alternative to conventional
"drilling and filling".
http://www.ncbi.nlm.nih.gov/pubmed/15209994
Oral Microbiol Immunol. 2004 Aug;19(4):240-6.
Efficacy
of ozone on survival and permeability of oral
microorganisms.
Nagayoshi
M, Fukuizumi T, Kitamura C, Yano J, Terashita M, Nishihara
T.
Abstract
In the present study, we examined the effect of ozonated
water on oral microorganisms and dental plaque. Almost no
microorganisms were detected after being treated with ozonated
water (4 mg/l) for 10 s. To estimate the ozonated water-treated
Streptococcus mutans, bacterial cells were stained with
LIVE/DEAD BacLight Bacterial Viability Kit. Fluorescence
microscopic analysis revealed that S. mutans cells were killed
instantaneously in ozonated water. Some breakage of ozonated
water-treated S. mutans was found by electron microscopy. When
the experimental dental plaque was exposed to ozonated water,
the number of viable S. mutans remarkably decreased. Ozonated
water strongly inhibited the accumulation of experimental dental
plaque in vitro. After the dental plaque samples from human
subjects were exposed to ozonated water in vitro, almost no
viable bacterial cells were detected. These results suggest that
ozonated water should be useful in reducing the infections
caused by oral microorganisms in dental plaque.
http://www.ncbi.nlm.nih.gov/pubmed/16911107
Eur J Oral Sci. 2006 Aug;114(4):349-53.
Antibacterial
effect of an ozone device and its comparison with two
dentin-bonding systems.
Polydorou
O, Pelz K, Hahn P.
Abstract
Microorganisms remaining beneath restorations can cause
secondary caries and pulp damage. Because of this, antimicrobial
treatment could be useful. The aim of this study was to evaluate
the antibacterial effect of the HealOzone device on
Streptococcus mutans and to compare it with the already proven
activity of two dentin-bonding systems. Thirty-five human molars
were divided into 5 groups. Cavities were then cut into the
teeth (n = 28 cavities per group). After sterilization, the
teeth were left in broth cultures of 10(6) colony-forming units
(CFU) ml(-1) of S. mutans at 36 degrees C for 48 h. The
appropriate treatment followed (group A, control; group B,
Clearfil SE Bond; group C, Clearfil Protect Bond; group D, 40 s
of treatment with ozone; and group E, 80 s of treatment with
ozone), and the cavities were then filled with composite resin.
After 72 h, the restorations were removed, dentin chips were
collected with an excavator, and the total number of
microorganisms was determined. All treatments significantly
reduced the number of S. mutans present compared with the
control group. The antimicrobial effect of both bonding systems
and treatment with 80 s of ozone was significantly higher than
the 40 s ozone treatment. In conclusion, HealOzone and the
bonding systems show striking antimicrobial effects against S.
mutans.
http://www.ncbi.nlm.nih.gov/pubmed/18280954
Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2008
Mar;105(3):e85-91. doi: 10.1016/j.tripleo.2007.10.006.
Effectiveness
of ozonated water on Candida albicans, Enterococcus
faecalis, and endotoxins in root canals.
Cardoso
MG, de Oliveira LD, Koga-Ito CY, Jorge AO.
Abstract
The aim of this study was to evaluate the effectiveness of
ozonated water in the elimination of Candida albicans,
Enterococcus faecalis, and endotoxins from root canals.
Twenty-four single-rooted human teeth were inoculated with C.
albicans and E. faecalis, and 24 specimens were inoculated with
Escherichia coli endotoxin. Ozonated water (experimental group)
or physiologic solution (control group) was used as irrigant
agent. Antimicrobial effectiveness was evaluated by the
reduction of microbial counts. Lipopolissacharide complex
presence was assessed by limulus amebocyte lysate test and
B-lymphocyte stimulation. Data were analyzed by Wilcoxon and
Mann-Whitney tests (5%). Ozonated water significantly reduced
the number of C. albicans and E. faecalis at the immediate
sampling, but increased values were detected after 7 days.
Ozonated water did not neutralize endotoxin. It could be
concluded that ozonated water was effective against C. albicans
and E. faecalis but showed no residual effect. No activity on
endotoxin was observed.
http://www.ncbi.nlm.nih.gov/pubmed/18618038
Quintessence Int. 2008 Mar;39(3):231-6.
The
disinfecting effect of ozonized oxygen in an infected root
canal: an in vitro study.
Stoll R,
Venne L, Jablonski-Momeni A, Mutters R, Stachniss V.
Abstract
OBJECTIVES:
To determine the disinfecting effect of ozonized oxygen (120
seconds from the HealOzone generator, KaVo) on Enterococcus
faecalis, representing bacteria that are difficult to eliminate
in the root canals of human teeth, and to compare it with the
conventional irrigants: sterile physiologic sodium chloride
solution (negative control group), 3% hydrogen peroxide
solution, 0.2% chlorhexidine solution, 1.5% sodium hypochlorite
solution, and 3% sodium hypochlorite solution (positive control
group).
METHOD AND
MATERIALS:
The roots (n = 10 in each group) were sterilized,
contaminated with the test microorganisms in a quantitative
preparation, rinsed with the test solutions, and dried. The
residual concentration of E faecalis was determined through
another irrigation stage with the sodium chloride solution.
RESULTS:
The positive control group showed a significantly lower
concentration of microorganisms than all the other groups,
whereas the negative control group showed a significantly higher
concentration compared to the other groups. The test groups
showed low concentrations.
CONCLUSION:
Ozonized oxygen appears to be suitable for disinfecting root
canal systems in cases where sodium hypochlorite is not
indicated.
http://www.ncbi.nlm.nih.gov/pubmed/17026511
Eur J Oral Sci. 2006 Oct;114(5):435-40.
Effect
of ozone on oral cells compared with established
antimicrobials.
Huth KC,
Jakob FM, Saugel B, Cappello C, Paschos E, Hollweck R,
Hickel R, Brand K.
Abstract
Ozone has been proposed as an alternative antiseptic agent
in dentistry based on reports of its antimicrobial effects in
both gaseous and aqueous forms. This study investigated whether
gaseous ozone (4 x 10(6) microg m(-3)) and aqueous ozone
(1.25-20 microg ml(-1)) exert any cytotoxic effects on human
oral epithelial (BHY) cells and gingival fibroblast (HGF-1)
cells compared with established antiseptics [chlorhexidine
digluconate (CHX) 2%, 0.2%; sodium hypochlorite (NaOCl) 5.25%,
2.25%; hydrogen peroxide (H(2)O(2)) 3%], over a time of 1 min,
and compared with the antibiotic, metronidazole, over 24 h. Cell
counts, metabolic activity, Sp-1 binding, actin levels, and
apoptosis were evaluated. Ozone gas was found to have toxic
effects on both cell types. Essentially no cytotoxic signs were
observed for aqueous ozone. CHX (2%, 0.2%) was highly toxic to
BHY cells, and slightly (2%) and non-toxic (0.2%) to HGF-1
cells. NaOCl and H(2)O(2) resulted in markedly reduced cell
viability (BHY, HGF-1), whereas metronidazole displayed mild
toxicity only to BHY cells. Taken together, aqueous ozone
revealed the highest level of biocompatibility of the tested
antiseptics.
http://www.ncbi.nlm.nih.gov/pubmed/19426912
Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2009
May;107(5):e73-9. doi: 10.1016/j.tripleo.2009.01.048.
Bactericidal
effect of KTP laser irradiation against Enterococcus
faecalis compared with gaseous ozone: an ex vivo study.
Kustarci
A, Sümer Z, Altunbas D, Kosum S.
Abstract
OBJECTIVE:
The objective of this study was to evaluate the
antimicrobial activity of potassium-titanyl-phosphate (KTP)
laser and gaseous ozone in experimentally infected root canals.
STUDY
DESIGN:
Eighty single-rooted teeth with straight canals were
selected. After preparation and sterilization, the specimens
were inoculated with 10 microL Enterococcus faecalis for 24
hours at 37 degrees C. The contaminated roots were divided into
2 experimental groups, 1 negative control group, and 1 positive
control group of 20 teeth each: Group 1, KTP laser group; Group
2, gaseous ozone group; Group 3, sodium hypochlorite group
(NaOCl) (negative control); and Group 4, saline group (positive
control). Sterile paper points used to sample bacteria from the
root canals were transferred to tubes containing 5 mL of brain
heart infusion broth. Then 10-microL suspension was inoculated
onto blood agar plates. The colonies of bacteria were counted
and data were analyzed statistically using Kruskal-Wallis 1-way
analysis of variance and Mann-Whitney U tests.
RESULTS:
There were statistically significant differences between all
groups (P < .05). The saline group had the highest number of
remaining microorganisms. Complete sterilization was achieved in
the 2.5% NaOCl group. The KTP laser and gaseous ozone did not
completely sterilize the root canals.
CONCLUSION:
Both KTP laser and gaseous ozone have a significant
antibacterial effect on infected root canals, with the gaseous
ozone being more effective than the KTP laser. However, 2.5%
NaOCl was superior in its antimicrobial abilities compared with
KTP laser and gaseous ozone.
http://www.ncbi.nlm.nih.gov/pubmed/22414842
J Endod. 2012 Apr;38(4):523-6. doi:
10.1016/j.joen.2011.12.020. Epub 2012 Feb 2.
Treatment
of root canal biofilms of Enterococcus faecalis with ozone
gas and passive ultrasound activation.
Case PD,
Bird PS, Kahler WA, George R, Walsh LJ.
Abstract
INTRODUCTION:
Biofilms of resistant species such as Enterococcus faecalis
pose a major challenge in the treatment of root canals with
established periapical disease. This study examined the effects
of gaseous ozone delivered into saline on biofilms of E.
faecalis in root canals of extracted teeth with and without the
use of passive ultrasonic agitation.
METHODS:
Biofilms of E. faecalis were established over 14 days in 70
single roots that had undergone biomechanical preparation
followed by gamma irradiation. The presence and purity of
biofilms were confirmed using scanning electron microscopy and
culture. Biofilms were treated with saline (negative control),
1% sodium hypochlorite for 120 seconds (positive control), ozone
(140 ppm ozone in air at 2 L/min delivered into saline using a
cannula for 120 seconds), saline with passive ultrasonic
activation (70 kHz and 200 mW/cm(2) applied to an ISO 15 file
held passively within the canal, for 120 seconds), and ozone
followed immediately by ultrasonic agitation. After treatment,
samples were taken from the biofilm and serially diluted for
plate counting.
RESULTS:
Analysis revealed that 1% sodium hypochlorite was the most
effective disinfecting agent followed by ozone combined with
ultrasonic agitation, ozone alone, and finally ultrasonic alone.
CONCLUSIONS:
Although none of the treatment regimes were able to reliably
render canals sterile under the conditions used, ozone gas
delivered into irrigating fluids in the root canal may be useful
as an adjunct for endodontic disinfection.
http://www.ncbi.nlm.nih.gov/pubmed/15892361
J Adhes Dent. 2005 Spring;7(1):29-32.
Effect
of ozone on enamel and dentin bond strength.
Schmidlin
PR, Zimmermann J, Bindl A.
Abstract
PURPOSE:
To evaluate the influence of direct high-dose gaseous ozone
application (2100 ppm) on dentin and enamel shear bond strength.
MATERIALS AND METHODS:
Ten bovine enamel and dentin samples per group were
pretreated as follows: (I) ozone application (Healozone, KaVo)
for 60 s alone or (II) with subsequent application of a
fluoride- and xylitol-containing antioxidant (liquid reductant),
(III) light-activated bleaching with 35% hydrogen peroxide for 5
min serving as negative control (Hi-Lite, Shofu), and (IV)
untreated enamel and dentin (positive control). Specimens were
bonded with a functional 3-step adhesive system (Syntac Classic,
Ivoclar Vivadent) and restored with a composite (Tetric Ceram,
Ivoclar Vivadent) according to the Ultradent method. After
storage in water at 37 degrees C for 24 h, shear bond strength
was measured using a Zwick universal testing machine. Data were
analyzed using ANOVA and Scheffe's post hoc analysis.
RESULTS:
In concordance with the existing literature, bleaching
resulted in significantly decreased bond strength (p < 0.05)
on enamel specimens. No decrease in shear bond strength was
detected for ozone-pretreated specimens compared to untreated
controls.
CONCLUSION:
Despite a possible retention of surface and subsurface
oxide-related substances during high-dose ozone application,
shear bond strength was not impaired. Thus, adhesive restoration
placement should be possible immediately after ozone application
for cavity disinfection.
http://www.ncbi.nlm.nih.gov/pubmed/19701509
J Adhes Dent. 2009 Aug;11(4):287-92.
Enamel
and dentin bond strength following gaseous ozone
application.
Cadenaro
M, Delise C, Antoniollo F, Navarra OC, Di Lenarda R, Breschi
L.
Abstract
PURPOSE:
To evaluate the effects of gaseous ozone application on
enamel and dentin bond strength produced by two self-etching
adhesive systems.
MATERIALS AND METHODS:
The shear bond strength test was conducted to assess
adhesion on enamel (protocol 1), while the microtensile bond
strength test was performed on dentin (protocol 2). Protocol 1:
96 bovine incisors were randomly divided into 4 groups, and
enamel surfaces were bonded in accordance with the following
treatments: (1E) ozone + Clearfil Protect Bond; (2E) Clearfil
Protect Bond (control); (3E) ozone + Xeno III; (4E) Xeno III
(control). Ozone gas was applied for 80 s. Shear bond strength
was measured with a universal testing machine. Protocol 2: 40
noncarious human molars were selected. Middle/deep dentin was
exposed and bonded in accordance with the following treatments:
(1D) ozone+Clearfil Protect Bond; (2D) Clearfil Protect Bond
(control); (3D) ozone+Xeno III (4D) Xeno III (control).
Four-mm-thick buildups were built on the adhesives, then
specimens were sectioned in accordance with the nontrimming
technique. Specimens were stressed until failure occurred, and
failure modes were analyzed. Shear bond and microtensile bond
strength data were analyzed using two-way ANOVA and Tukey's
post-hoc test.
RESULTS:
No statistical differences were found between ozone treated
specimens and controls, neither on enamel nor on dentin
irrespective of the tested adhesive. Clearfil Protect Bond
showed higher bond strength to enamel than Xeno III,
irrespective of the ozone treatment (p < 0.05).
CONCLUSION:
The use of ozone gas to disinfect the cavity before placing
a restoration had no influence on immediate enamel and dentin
bond strength.
http://www.ncbi.nlm.nih.gov/pubmed/21417122
J Clin Pediatr Dent. 2010 Winter;35(2):187-90.
Effect
of ozone pretreatment on the microleakage of pit and fissure
sealants.
Cehreli
SB, Yalcinkaya Z, Guven-Polat G, Cehreli ZC.
Abstract
OBJECTIVE:
This study investigated the effect of ozone pretreatment on
the microleakage and marginal integrity of pit and fissure
sealants placed with or without a self-etch 6th generation
adhesive.
STUDY DESIGN:
Freshly-extracted, human third molars were randomly assigned
into two main groups (n = 48): Group A: Fissures were pretreated
with ozone; Group B: Fissures were left untreated. The teeth
were further randomly divided into two subgroups (n = 24/each)
so that half of teeth were sealed with a conventional fissure
sealant (Fissurit F, Voco, Germany), while the remaining half
received the same sealant bonded with a self-etch adhesive
(Clearfil Protect Bond, Kuraray, Japan). Following thermal
cycling (1000X), the specimens were subjected to dye penetration
within 0.5% basic fuchsin for 24h. The extent of dye penetration
was measured by image analysis. Kruskal Wallis and Mann-Whitney
U tests were used for statistical analysis of the data (p =
0.05). Two randomly-selected sections from each group were
observed under SEM RESULTS: In all groups, ozone pretreatment
significantly reduced the extent of microleakage (p < 0.001).
SEM investigation demonstrated better adaptation of the sealants
in ozone-pretreated groups. Clearfil Protect Bond did not
improve the marginal seal of Fissurit F (p > 0.05).
CONCLUSION:
Ozone pretreatment favorably affected the marginal sealing
ability of the tested fissure sealants.