Ozone as an adjunct to conventional nonsurgical therapy in chronic periodontitis: a randomized controlled clinical trial

Comparative evaluation of ozonized water versus normal saline irrigation with mechanical debridement in chronic periodontitis patients - A clinical study

Background

Ozone therapy is a rather novel approach for managing many diseases, encompassing oral disorders such as tooth caries and periodontal disease. It possesses the ability to disrupt microbial cell walls, resulting in rapid cell lysis. Moreover, characteristics of ozone such as anti-inflammation, stimulation and modulation of immunity contribute to mitigating the host response aspect of periodontal disease.

Objective

To assess the adjunctive advantages of irrigation of ozonized water in conjunction with mechanical debridement for the treatment of periodontitis.

Methodology

50 patients with chronic periodontitis and pocket probing depth ≥4 have been divided into 2 groups i.e. Test (n = 25) and control groups (n = 25). While the control group was administered normal saline irrigation and mechanical debridement, the test group was given ozonized water irrigation. Evaluations were conducted at baseline and four weeks following treatment to determine the plaque score, bleeding score, pocket probing depth, and clinical attachment level.

Results

Clinical measures such as clinical attachment level, pocket probing depth, bleeding index, and plaque index, significantly improved with adjunctive ozone water irrigation. The frequency of sites with bleeding on probing that had a pocket depth ≥4 mm was significantly reduced as a result of ozone water irrigation.

Conclusion

Ozone irrigation alongside nonsurgical periodontal therapy offers adjunctive benefits by reducing clinical parameters.

Effects of ozone therapy as an adjuvant in the treatment of periodontitis: a systematic review and meta-analysis

BACKGROUND

Chronic periodontitis is an infectious disease initiated by plaque, which affects chewing and even general health. Ozone therapy, as a complementary means in the treatment of chronic periodontitis, numerous clinical trials have been conducted. We conducted this review to evaluate the effect of the ozone use accompanied by scaling and root planning (SRP) in periodontal treatment.

METHODS

Randomized controlled trials investigating the use of ozone therapy in chronic periodontitis. The search was carried out across PubMed, Cochrane Central Register of Controlled Trials, and EMBASE databases with the search period extending to July 2024. The quality of the identified studies was evaluated using the Cochrane Collaboration's Risk of Bias tool. The results were presented as weighted mean differences (WMD) with corresponding 95% confidence intervals (95% CI). Heterogeneity among the studies was assessed using the I2 test. Data analysis was performed using RevMan 5.4 and Stata 16.0.

RESULTS

Thirteen articles meeting the inclusion criteria. The meta-analysis revealed statistically significant differences in probing depth (PD) and gingival index (GI) reduction between ozone-assisted nonsurgical periodontal treatment and placebo-assisted treatment in patients with chronic periodontitis (P < 0.05). However, no significant differences were observed in clinical parameters such as bleeding on probing (BOP) percentage, plaque index (PI), and clinical attachment level (CAL) (P > 0.05).

CONCLUSION

Ozone therapy combined with SRP is superior to SRP alone in improving PD and GI indexes in patients with periodontitis, without increasing adverse reactions, and the effect is worthy of recognition. The research evidence indicates that ozone therapy in patients with chronic periodontitis has a positive effect.

Effect of ozone oil and non-surgical periodontal treatment in patients with type 2 diabetes. In-vivo and in-vitro studies with fibroblasts and Candida albicans

AIM

To evaluate the clinical effectiveness of ozonated sunflower oil (Oz) as an adjunctive of non-surgical periodontal therapy in patients with type 2 diabetes mellitus (DM2), on fibroblast cell viability and migration and the effectiveness of Oz on a Candida albicans (C. albicans) culture.

METHODOLOGY

In total, 32 sites in 16 DM2 with moderate to advanced periodontal disease with periodontal pocket depths ≥5mm were selected. The treatments were divided into two groups: control, saline solution (SS) as an adjunctive of scaling and root planing (SRP+SS), and test, Oz as an adjunctive of SRP (SRP+Oz). Hematological [fasting glucose level (FGL) and hemoglobin A1c (HbA1c)] and microbiological samples were collected from the participants at baseline and three months after periodontal treatment and the microbiological samples were analyzed by PCR. C. albicans was previously tested by the agar diffusion test. The effect of Oz was tested on cell viability and fibroblast migration.

RESULTS

The groups showed no statistically significant differences (paired t-test-p>0.05) regarding hematological parameters, FGL (median - baseline 171.41, 3 months 164mg/dL), and HbA1c (baseline 8%, 3 months 7.5%) (Kruskal-Wallis One-Way Nonparametric-p>0.05) after periodontal therapy. The groups showed statistical differences for periodontal parameters between baseline and three months (paired t-test-p<0.05). PCR analysis showed a reduction in the percentage of C. albicans in the SRP+Oz group after three months (McNemar's test-p=0.002). Cell viability was lower in the high glucose Dulbecco's modified Eagle's medium (4500 mg/L) than in low glucose (1000 mg/L) (RM-ANOVA-p<0.0001). The wound healing test showed reduced fibroblast migration (one-way ANOVA with Dunnett's post-test-p<0.01). Oz showed high C. albicans antifungal inhibition (Kruskal-Wallis test-p=0.0001).

CONCLUSIONS

SRP+Oz effectively reduced C. albicans in-vitro and in-vivo but showed no clinical improvements compared to the control. Cell viability and wound healing of fibroblasts showed no improvements.

Clinical and radiographic evaluation of non-surgical therapy with and without ozone gel application in controlled type 2 diabetic patients with periodontitis: a randomized controlled clinical trial

BACKGROUND

The current study aimed to assess the clinical and radiographic outcomes of the effect of subgingival application of ozonated gel as an adjunct to scaling and root planing (SRP) in diabetic patients with stage III periodontitis.

METHODS

Twenty-four patients with type II diabetes mellitus (DM) were randomized into two groups, with 12 patients in each group. Group I served as the intervention group, receiving both SRP and ozone gel application (SRP + Ozone), while Group II served as the control group, undergoing SRP alone. Clinical attachment level was evaluated as primary outcome, with secondary outcomes including probing pocket depth, full mouth plaque score, full mouth bleeding score, dentinal hypersensitivity, radiographic linear defect depth, radiographic defect angle, and periodontal ligament widening space assessed at 3 and 6 months.

RESULTS

The results revealed statistically significant intragroup differences between the two groups (p < 0.05). In contrast, intergroup differences revealed no statistically significant difference across the various time intervals (p > 0.05). The reduction in PD in the SRP + Ozone group at three months was statistically significant (p = 0.04). The SRP + Ozone group showed a significant radiographic improvement compared to the SRP group. The Visual Analogue Scale (VAS) also demonstrated statistically significant differences between the two groups. Glycated hemoglobin (HbA1c) significantly decreased after 6 months, with no significant signifcant differences between groups (p > 0.05).

CONCLUSIONS

Ozone gel is suggested to be a promising potential natural adjunctive therapy for diabetic patients to enhance periodontal health, with no reported adverse effects.

TRIAL REGISTRATION

ID: NCT05538078, Date of Registration: 09/09/2022. ( https://register.

CLINICALTRIALS

gov/prs/app/action/DownloadReceipt?uid=U0006D54&ts=3&sid=S000CGX4&cx=g1wreh ).

Surgical regenerative methods for peri-implantitis treatment: A systematic review and meta-analysis

Background

The purpose of this study was to review the literature on the efficacy of different surgical regenerative methods for peri-implantitis treatment.

Methods

A preliminary search was conducted in seven electronic databases. The studies included in the analysis implemented surgical regenerative treatment in at least one study group. Baseline and follow-up values for bleeding on probing (BoP), pocket depth (PD), plaque index (PI), bone level (BL), and bone gain (BG) were extracted. The standardized mean difference (SMD) was calculated using Cohen's d or Hedges' g, and a random-effects-restricted maximum likelihood (REML) method was applied for the meta-analysis.

Results

Fifteen studies were included in the qualitative synthesis. The meta-analysis was performed on six studies comparing regenerative techniques that involved bone grafts with those that did not. The overall effect size for using bone grafts at the one-year follow-up was 0.04 (95% CI: -0.26‒0.35; P=0.78) for BoP, -0.08 (95% CI: -0.42‒0.27; P=0.66) for PD, 0.37 (95% CI: 0.08‒0.65; P=0.01) for PI, -0.44 (95% CI: -0.84 to -0.03; P=0.03) for BL, and 0.16 (95% CI: -0.68‒1.01; P=0.70) for BG.

Conclusion

Various materials have been employed for peri-implant defect filling and coverage. A bone substitute did not significantly improve BoP, PD, and BG values, while PI and BL were significantly ameliorated at one-year follow-up. However, recommending a single unified protocol as the most effective for surgical regenerative treatment of peri-implantitis was not feasible.

Insights into Intra Periodontal Pocket Pathogenesis, Treatment, In Vitro-In Vivo Models, Products and Patents, Challenges and Opportunity

Periodontal disease is a multifactorial pathogenic condition involving microbial infection, inflammation, and various systemic complications. Here, a systematic and comprehensive review discussing key-points such as the pros and cons of conventional methods, new advancements, challenges, patents and products, and future prospects is presented. A systematic review process was adopted here by using the following keywords: periodontal diseases, pathogenesis, models, patents, challenges, recent developments, and 3-D printing scaffolds. Search engines used were "google scholar", "web of science", "scopus", and "pubmed", along with textbooks published over the last few decades. A thorough study of the published data rendered an accurate and deep understanding of periodontal diseases, the gap of research so far, and future opportunities. Formulation scientists and doctors need to be interconnected for a better understanding of the disease to prescribe a quality product. Moreover, prime challenges (such as a lack of a vital testing model, scarcity of clinical and preclinical data, products allowing for high drug access to deeper tissue regions for prolonged residence, lack of an international monitoring body, lack of 4D or time controlled scaffolds, and lack of successful AI based tools) exist that must be addressed for designing new quality products. Generally, several products have been commercialized to treat periodontal diseases with certain limitations. Various strategic approaches have been attempted to target certain delivery regions, maximize residence time, improve efficacy, and reduce toxicity. Conclusively, the current review summarizes valuable information for researchers and healthcare professional to treat a wide range of periodontal diseases.

Effectiveness of Ultrasonic and Manual Instrumentation in Nonsurgical Periodontal Therapy: Are Additional Therapies More Effective? A Systematic Review

Nonsurgical periodontal therapy aims to remove supragingival and subgingival biofilm to restore periodontal health. This systematic review aims to assess the clinical effectiveness of manual and/or ultrasonic instruments and to determine whether other therapies can improve periodontal clinical outcomes. Case-control, cross-sectional and cohort studies and clinical trials of patients undergoing nonsurgical periodontal therapy with ultrasonic and/or manual instruments (and any adjunctive therapies, such as glycine, erythritol, ozone, laser and glycine) from 2013 to 2023 were analyzed using Pub-med/MEDLINE, Scopus and Google Scholar. To assess the risk of bias in this review, blinding, randomization, allocation concealment, outcome data and outcome recording were assessed. No differences between treatments were found; all methods, including manual and ultrasound, were helpful in improving clinical parameters (primary outcome). Although the results were mixed, adjunctive therapies seemed to be helpful in the treatment of periodontal disease. The results of this systematic review are consistent with the previous scientific literature and have shown that both manual and ultrasonic instruments are effective in nonsurgical periodontal therapy. This review could not show how complementary therapies could further improve nonsurgical periodontal therapy. For future research, it would be good to standardize the sample with regard to the degree and stage of periodontal disease and to evaluate the risks and benefits of the instruments (manual and ultrasonic scalers).

Ozone Therapy as an Adjuvant in the Treatment of Periodontitis

The current study aimed to assess the efficacy of ozone therapy in the treatment of stage II and stage III periodontitis. This prospective split-mouth study selected patients who were diagnosed with either stage II or stage III periodontitis. All patients were treated with scaling and root-planing (SRP) on the control side and SRP with ozone therapy on the test side. Probing depth (PD), clinical attachment loss (CAL), O'Leary plaque index (PI), and bleeding on probing (BOP) scores were recorded at baseline and six weeks after the SRP treatment. A total of 46 patients were selected for this study, including 31 males and 15 females. All periodontal variables (PD, CAL, PI, and BOP) showed significant changes (p < 0.0001) from baseline to six weeks. Moreover, significant changes (PD = 0.0001, CAL = 0.0001, PI = 0.042 and BOP = 0.0001) were also observed between the control and test sides. Gender showed no significance on periodontal variables (p > 0.05) except PD on the test side (p = 0.030). In addition, periodontal stages and grades showed no significant changes (p > 0.05) in any periodontal variables on both sides. Ozone therapy significantly improves the periodontal condition compared to SRP treatment alone. However, the stages and grades of periodontitis do not influence the outcome of ozone therapy.

Effect of 20-ppm ozone and 1% chlorhexidine gels on plaque index and Streptococcus mutans counts in the dental plaque in 6-12-year-old children: A randomized, double-blind clinical trial

Background

One of the methods to control dental caries is to use ozone. Since it is difficult for children to use mouthwashes, the present study aimed to evaluate 20-ppm zone and 1% chlorhexidine (CHX) gels' effects on the plaque index and Streptococcus mutans counts in 6-12-year-old children.

Methods

In the present double-blind clinical trial, 165 children, 6-12 years of age, referring to the Department of Pediatric Dentistry, Tabriz Faculty of Dentistry, were selected based on inclusion and exclusion criteria and randomly assigned to three groups: ozone gel, CHX gel, and control. The subjects were instructed to place an adequate amount of the gels on all the surfaces of their teeth with one clean finger. The patients and evaluators were blinded to the study groups. The plaque index and S. mutans counts in plaque samples were determined before intervention and three weeks after intervention on the buccal surface of the most posterior maxillary tooth (left or right). S. mutans counts were determined by culture. STATA software version 14 was used for statistical analyses using Wilcoxon, Kruskal-Wallis, and post hoc Dum tests. Statistical significance was defined at P<0.05.

Results

The 20-ppm ozone and 1% CHX gels significantly decreased dental plaque compared to the control group (P<0.05), and their effects were similar (P>0.05). These gels significantly decreased the colonies and bacterial counts of S. mutans (P<0.05).

Conclusion

The performance of 20-ppm ozone gel in decreasing the dental plaque and S. mutans counts was similar to 1% CHX gel.

An Assessment of Knowledge and Awareness Regarding Ozone Dentistry Among Dental Students at King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Kingdom of Saudi Arabia

Background The field of dentistry is evolving as a result of the increased utilization of contemporary scientific knowledge in dental procedures. When compared to traditional medical treatments like antibiotics and disinfectants, ozone therapy is more budget-friendly, reliable, and conservative. Ozone therapy has proven more effective than the standard treatments available today. Ozone treatment shortens treatment time and eradicates bacterium counts. The fact that there is no discomfort involved with the procedure also helps to boost patient acceptance. Clinical research on the use of ozone in dentistry is limited compared to the amount of research conducted in laboratories. The intent is to assess the knowledge and awareness about ozone dentistry among dental students at King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia. Materials and Methods In this examination, a cross-sectional study was undertaken using a questionnaire that has been pre-validated and pre-tested. A total 201 individuals of BDS graduates took part in the survey. Non-probability convenience sampling was used for selecting the samples. The IBM SPSS Statistics, version 25.0 (IBM Corp., Armonk, NY), was used to statistically analyze the collected data. Descriptive statistics in the form of frequencies and percentages were used. To determine the degree of significance, Pearson's chi-squared test was used; results were deemed significant if p < 0.05. Using Lawshe's method, the questionnaire's validity was examined. Results The study population included 65 men (48.87%) and 68 females (51.12%), with 22.75 ± 0.76 as the population's mean age. The research included 51.87% (69) third-year students and 48.12% (64) final-year students. In all, 53.38% knew about dental ozone. Meanwhile, 82.70% of respondents believed that the primary chemical characteristic of ozone is its oxidative nature (p = 0.021), and 78.19% utilized aqueous ozone for hospital disinfection (p = 0.008). With a p = 0.007, 36.84% recognized that ozonated oil is an intra-canal dressing or medicine. Moreover, 37.59% and 42.85% assess gaseous ozone's microbicidal and wound-healing properties accordingly (p = 0.037, statistically significant). The correlation was calculated using Pearson's test with a high level of significance between age and gender as well as gender and awareness (p = 0.01). A statistically significant relationship was found between age and awareness (p = 0.036). Conclusion The clinical application of ozone is a minimally invasive technique for the prevention and treatment of dental disorders. In order to establish ozone therapy as a widely accepted treatment modality in dental practice, it is necessary to do additional research in the field of dentistry. This research should involve controlled clinical studies that have an adequate follow-up duration and utilize standardized metrics. Although ozone therapy has been demonstrated to be effective, its utilization in the field of dentistry is not commonly practiced.

Is Ozone a Valid Adjuvant Therapy for Periodontitis and Peri-Implantitis? A Systematic Review

INTRODUCTION

Ozone is a naturally occurring unstable compound with three oxygen atoms that generally transforms into an oxygen molecule, releasing one oxygen atom. This feature has been exploited in dentistry for numerous applications, including for periodontal diseases and peri-implantitis.

METHODS

This review was performed in relation to the PRISMA flow chart and was annotated in the PROSPERO register. PICO questions were used as research questions. The risk of bias in the non-randomized clinical trials was appraised using the ROBINS-I tool.

RESULTS

An electronic search found a total of 1073 records, in particular, 842 from MEDLINE/PubMed, 13 from Bio Med Central, 160 from Scopus, 1 from the Cochrane library databases, and 57 from the PROSPERO register. A total of 17 studies were included in the present systematic review. Information regarding the characteristics of the periodontal clinical and radiographic parameters for gaseous ozone, ozonate water, ozonate oil, and ozone gel, including clinical attachment loss (CAL) probing depth (PPD), bleeding on probing (BoP), plaque index (PI), gingival index (GI), and marginal bone levels (MBL), were obtained.

CONCLUSIONS

The studies included in this systematic review show different results regarding the ozone in periodontal treatment in association with or without SRP.

Effect of Ozonated Water on Oral Mucositis and Pain Induced by Head and Neck Radiotherapy: A Cross-sectional Study

Background: Oral mucositis and local pain are the negative effects of the treatment of head and neck cancer with radiotherapy. Objectives: The study aimed to investigate the effect of ozonated water on the severity of mucositis and pain in (1) patients who were treated with ozonated water and (2) patients who were not treated with ozonated water. Methods: We randomly divided 93 patients with head and neck malignancy (aged 18 to 80) into three groups. Ozone-treated group 1 rinsed their mouth with 15 mL of ozonated water with a concentration of 20 - 50 ppm from the first session of radiotherapy for one minute before and after each session. Ozone-treated group 2 rinsed their mouth with 15 mL of ozonated water with a concentration of 20 - 50 ppm for three minutes and then swallowed it before and after each session. Ozone-treated groups 1 and 2 and the non-ozone-treated group received standard treatment if mucositis symptoms appeared in each patient. The minimum number of radiotherapy sessions was 30, and the minimum planned dose for each patient was 50 Gray. Anamnesis and the following clinical parameters were taken: the degree of mucositis, the use of corticosteroids, radiotherapy method, radiation dose, and Pain Visual Analog Scale. Multi-level and subgroup analyses were performed on the ozone-treated and non-ozone-treated levels. Results: The mean degrees of oral mucositis and pain were lower in the ozone-treated group 2 than in the ozone-treated group 1 and non-ozone-treated group (P < 0.05). The non-ozone-treated group had the highest degrees of oral mucositis and pain severity (P < 0.05). The Kruskal-Wallis H test showed that there was a statistically significant difference in the Visual Analog Scale of sessions 5, 10, 15, 20, 25, and 30 between different groups. However, there was no statistically significant difference in the Visual Analog Scale of session 1 (χ2 (2) = 1.022, P = 0.6). This study revealed that ozonated water can be used for preemptive pain control and mucositis. This finding aligned with previous studies. Also, former research proved the safety and efficacy of ozonated water in dentistry and medical uses. Conclusions: The use of ozonated water in patients with head and neck malignancy can reduce the pain severity and oral mucositis induced by radiotherapy. It seems that ozonated water can be used as a preemptive agent in patients who receive head and neck radiotherapy.

New tendencies in non-surgical periodontal therapy

The aim of this review was to update the evidence of new approaches to non-surgical therapy (NSPT) in the treatment of periodontitis. Preclinical and clinical studies addressing the benefits of adjunctive antimicrobial photodynamic therapy, probiotics, prebiotics/synbiotics, statins, pro-resolving mediators, omega-6 and -3, ozone, and epigenetic therapy were scrutinized and discussed. Currently, the outcomes of these nine new approaches, when compared with subgingival debridement alone, did not demonstrate a significant added clinical benefit. However, some of these new alternative interventions may have the potential to improve the outcomes of NSPT alone. Future evidence based on randomized controlled clinical trials would help clinicians and patients in the selection of different adjunctive therapies.

Adjunctive benefit of ozonized water irrigation with mechanical debridement in the management of Stage III periodontitis: A randomized controlled clinical and biochemical study

OBJECTIVE

Periodontitis is a chronic inflammatory disease initiated by dysbiotic microbiota. Conventional mechanical debridement often needs adjunctive measures to control the disease process. The objective of the present study was to find out benefit of ozonized water irrigation along with nonsurgical periodontal therapy for the management of periodontitis.

METHODS

We have conducted a randomized controlled, triple-blinded, parallel-group clinical trial. The test group (n = 25) was treated with ozonized water irrigation, whereas the control group (n = 25) received normal saline irrigation along with mechanical debridement. Full mouth plaque score, bleeding score, probing pocket depth and clinical attachment loss were evaluated at baseline and 4 weeks after treatment. Salivary interleukin 1 beta was analysed using enzyme linked immunosorbent assay. Analysis of covariance, t test and chi-square test were used for intergroup comparison. Intragroup comparison was done using the paired t test.

RESULTS

Adjunctive ozone water irrigation resulted in significant improvement in all clinical parameters, except probing pocket depth after adjusting the extraneous effects due to initial confounding factors (p < 0.001). But as per subgroup analysis, ozone water irrigation resulted in significant reduction in pocket depth in deep pockets (p = 0.01) and the number of sites with a pocket depth ≥4 mm with bleeding on probing. Salivary interleukin 1 beta also reduced significantly in the test group after therapy.

CONCLUSION

Ozone irrigation provides adjunctive benefit along with nonsurgical periodontal therapy in reducing clinical parameters and inflammatory mediators in saliva. But long-term benefits need to be assessed with future studies. The study was registered in the Clinical Trial Registry of India (CTRI no: CTRI/2020/06/026275).

Ozone Gel in Chronic Periodontal Disease: A Randomized Clinical Trial on the Anti-Inflammatory Effects of Ozone Application

The search for new topical treatments able to display not only antimicrobial properties but also a multiplicity of other beneficial effects while expressing safe cytocompatibility toward host tissues is being progressively developed. Antiseptics represent an aid to the gold standard nonsurgical treatment Scaling-and-Root-Planing (SRP) for periodontal disease. This split-mouth study aims to assess the efficacy of the ozonized gel GeliO3 (Bioemmei Srl, Vicenza, Italy) plus SRP (experimental treatment), with respect to SRP + chlorhexidine gel. Ten participants were treated with SRP + chlorhexidine gel (control sites) and with SRP + ozone gel (trial sites). After 1 (T1) and 3 months (T2) from baseline (T0), patients were revisited. At each time-point, the following indexes were assessed: probing pocket depth (PPD), clinical attachment level (CAL), gingival index (GI), plaque index (PI), and bleeding on probing (BoP). It has been assessed that the use of the ozonized gel in addition to SRP did not show significant differences if compared to conventional SRP + chlorhexidine. Chlorhexidine was found to be more effective than ozone in reducing CAL and GI at T2. Ozone deserves consideration for its wide applicability in several clinical fields. In this connection, we also glance at the latest research on ozone therapy.

A meta-analysis of ozone effect on tooth bleaching

This systematic review assessed the effectiveness of ozone (O₃) in the color change of in-office tooth bleaching in vital teeth (TB) and the sensitivity control. Only randomized controlled clinical trials were included. Seven databases were used as primary search sources, and three additional sources were searched to capture the "grey literature" partially. The JBI tool was used to assess the risk of bias. TB was assessed using the ΔELab color change metric comparing tooth color pre- and post-bleaching. We meta-analyzed the ΔELab estimates per method and calculated the absolute standardized mean difference using random-effect models. The GRADE approach assessed the certainty of the evidence. The ΔELab estimates ranged from 1.28 when the O₃ was used alone to 6.93 when combined with hydrogen peroxide (HP). Two studies compared O₃ and HP alone, but their TB was similar (SMD = - 0.02; 95%CI: - 0.54; 0.49). The bleaching effectiveness for the combination of O₃ + HP compared to HP was similar (SMD = 0.38; 95%CI: - 0.04; 0.81). Thus, based on the available literature, our findings suggest that O₃ is not superior to the conventional technique using HP on the change of tooth color. The O₃ did not present sensitivity when used alone. When O₃ was used in combination with HP, patients reported hypersensitivity only when O₃ was applied before HP, i.e., no sensitivity was perceived when O₃ was applied after HP.

Professionally Delivered Local Antimicrobials in the Treatment of Patients with Periodontitis-A Narrative Review

This review sheds light on the recent published scientific evidence relating to the use of professionally delivered local antimicrobial agents (LA’s). The review also analyses drug delivery systems available to date and provides an update on the latest scientific evidence about the benefits, limitations, and clinical results obtained by use of local drugs in the treatment of periodontal disease. The search strategy revealed randomized controlled trials (RCTs) that compared the efficacy of adjunctive LA’s to mechanical therapy alone. Based on the available evidence gathered from this review, we can infer that the use of local antimicrobial agents in conjunction to scaling and root debridement (SRD) delivers significant benefits in periodontal therapy and it is a useful aid, avoiding many of the side effects that systemic antibiotic therapy may involve. Local drug delivery (LDD) is an efficient and effective means of delivering drugs based on the evidence presented in the review. The authors of this review would suggest the use of local antimicrobials in cases of localized periodontitis or individual areas that do not respond to the usual mechanical therapy alone. This review summarizes the current use of local drug delivery in periodontal management ensuring that the general practitioners are able to choose an appropriate local antimicrobial.

Antibiofilm effect of ozonized physiological saline solution on peri-implant-related biofilm

BACKGROUND

Removal of dental plaque and local application of local chemical adjuncts, such as chlorhexidine (CHX), have been used to control and treat peri-implant disease. However, these methods can damage the surface properties of the implants or promote bacterial resistance. The application of ozone as an adjunctive treatment represents a new approach in the management of peri-implantitis. Thus, the purpose of this study was to evaluate the antimicrobial effect of ozonized physiological saline solution in different concentrations against oral biofilms developed on titanium surface.

METHODS

Single and multi-species biofilms of Porphyromonas gingivalis, Fusobacterium nucleatum, and Streptococcus oralis were formed on titanium specimens for 5 days in anaerobic conditions. Biofilms were treated with ozonized saline solution at different concentrations (25, 50, and 80 μg/NmL), for 30 seconds and 1 minute. CHX (0.12%) and saline solution (0.89% NaCl) were used as positive and negative controls, respectively. Bacterial viability was quantified by colony forming units (CFU mL^-1 ), and biofilm images were acquired by confocal laser scanning microscopy (CLSM). Data were analyzed by parametric test (ANOVA) with Tukey post-hoc test (P < 0.05).

RESULTS

Ozonized saline solution showed antibiofilm activity at a concentration of 80 μg/NmL for 30 seconds and 1 minute, reducing, mainly, Porphyromonas gingivalis viability, with 2.78 and 1.7 log₁₀ CFU mL^-1 of reduction in both single and multi-species biofilms, respectively, when compared to the control (saline), whereas CHX reduced 1.4 and 1.2 log₁₀ CFU mL^-1 .

CONCLUSION

Ozonized saline solution has antibiofilm activity, with better effect when applied for 1 minute at 80 μg/NmL, being a promising candidate therapy for the treatment of peri-implant diseases.

Ozone Therapy in Periodontics: A Meta-analysis

Gingival and periodontal diseases constitute a major distress in the field of dentistry. The greater part of the contributing and etiologic factors are diminished or treated with all forms of ozone. Ozone which is well known for its antimicrobial and tissue regenerative properties is indicated in all the stages of gingival and periodontal diseases. The aim of this study was to review literature on the effects of ozone as an adjunct to mechanical therapy in periodontitis patients. A search of literature was conducted to identify articles of ozone therapy in periodontitis published during the period from January 1, 2010, to July 30, 2018. PubMed, Medline, Embase, Cochrane, and Google Scholar search and hand searching of journals were conducted to identify relevant articles. The search strategy employed both dental subject headings and free-text terms. Out of a total of 123 studies that fit the initial inclusion criteria, 117 studies were further excluded. Only six studies were included in the meta-analyses. A high level of heterogeneity in the selected studies was found as demonstrated by Q-value of 10.241 and I² value of 80.49%. However, the funnel plots showed symmetrical shape, with prevalence studies indicating absence of publication bias. Ozone therapy can be used effectively as an adjunct to scaling and root planing in the treatment of periodontitis.

[Effect of scaling and root planing on serum C-reactive protein levels in patients with moderate to severe chronic periodontitis: a systematic review and Meta-analysis]

OBJECTIVE

To evaluate the effect of scaling and root planing (SRP) on serum C-reactive protein (CRP) levels in patients with moderate to severe chronic periodontitis.

METHODS

We searched the PubMed, Web of Science, EMBASE, Cochrane, CNKI, Wanfang, and VIP databases from the inception to July 8th, 2019. Two reviewers independently screened literature, extracted data, and evaluated the bias risk of included studies. Then, a meta-analysis was performed using RevMan 5.3 software.

RESULTS

A total of 13 randomized controlled clinical trials and 12 prospective clinical trials were included. Meta-analysis showed that serum CRP levels decreased at 2 and 3 months after SRP (P<0.05), and no significant difference in serum CRP levels was found at 6 months (P=0.49).

CONCLUSIONS

SRP can reduce serum CRP levels in systematically healthy patients with moderate to severe chronic periodontitis at 2 and 3 months after SRP.

Ineffectiveness of ozone therapy in nonsurgical periodontal treatment: a systematic review and metaanalysis of randomized clinical trials

OBJECTIVE

This systematic review (SR) aimed at assessing the adjunctive clinical effect of ozone therapy (OT) on nonsurgical periodontal treatment.

MATERIALS AND METHODS

Articles published prior to September 2019 were electronically searched in four databases without any other date or language restrictions and manually searched in regular journals and in gray literature. This review was performed according to the PICO format. The eligibility criteria comprised randomized controlled trials (RCTs) that analyzed the adjunctive effect of OT on nonsurgical periodontal treatment.

RESULTS

Twelve studies published between 2010 and 2019 were included in this SR. A metaanalysis of ten reports showed that there was no statistically significant difference in the periodontal parameters analyzed when scaling and root planing (SRP) plus sulcus irrigation with ozonated water or sulcus insertion of ozonated gas were used when compared to SRP alone. Additionally, there was no significant difference when the effect of SRP plus ozonated water was compared with SRP plus 2% chlorhexidine gluconate (CLX). No studies reported significant microbiological differences when the use of ozone was compared with SRP alone.

CONCLUSIONS

The results of this SR do not support the use of OT for nonsurgical periodontal treatment. However, due to the potential heterogeneity across the studies, the presence of confounding factors, and the short follow-up of some included RCTs, these results should not be considered definitive.

CLINICAL RELEVANCE

The current evidence indicates that ozone has antimicrobial activity and good biocompatibility with periodontal cells and gingival fibroblasts. However, no evidence was found for a positive effect of OT as an adjunct to scaling and root planing.

Is low level laser therapy or ozone therapy more effective for bone healing? Understanding the mechanisms of HIF-1α, RANKL and OPG

Periodontitis is a common chronic infection of dental tissues. Ozone therapy (OT) and low level laser therapy (LLLT) are useful treatments for periodontitis. We investigated the effects of OT and LLLT on periodontal disease-induced bone destruction in rats with experimentally induced periodontitis (EP). We used 30 male Wistar rats divided into three groups: control, OT and LLLT. EP was induced by placing a 3.0 silk suture around the cervix of the left mandibular first molar tooth. OT was performed using an ozone generator at 80% concentration. LLLT was applied using a diode laser. Both OT and LLLT were performed for two weeks at two day intervals. Histomorphometric and immunohistochemical analyses also were performed. Alveolar bone loss was significantly less in the LLLT group compared to the control group. The number of HIF-1α positive cells was significantly less in the LLLT group compared to the control group. We found significantly fewer RANKL-positive cells in the OT group compared to the control group. The number of osteoprotegerin (OPG) positive cells was significantly greater for the LLLT group than for the control group. Although both treatments produced positive effects, LLLT appears to be more effective for increasing alveolar bone formation.

Evaluation of the effect of topical and systemic ozone application in periodontitis: an experimental study in rats

Objective:

The goal of the present study was to determine the effect of systemic and topical ozone application on alveolar bone loss (ABL) by evaluating the effect of Hypoxia-inducible factor −1 alpha (HIF-1-α) and receptor activator of NF-kB ligand (RANKL)-positive cells on histopathological and immunohistochemical changes in a rat periodontitis model.

Methodology:

Thirty male Wistar rats were divided into three groups: 1) Group C (control group); 2) Group SO (systemic ozone group) and 3) Group TO (topical ozone group). Experimental periodontitis was induced with a 3/0 silk suture placed at the mandibular left first molars of rats, and the suture was removed 14 days later. Ozone gas was injected intraperitoneally (0.7 mg/kg) in SO group. Topical ozone application protocol was performed using an ozone generator at 80% concentration (4^th grade) 90- degree probe for the duration of 30 s. Both ozone applications were carried out for two weeks at intervals of two days. Histomorphometric and immunohistochemical analysis were performed.

Results:

ABL was significantly lower in Group SO compared to Group C (p: 0.0052). HIF-1α- positive cells were significantly lower in Group TO than in Group C (p: 0.0043). RANKL-positive cells were significantly lower in Group SO and in Group TO compared to the control group (p: 0.0033, p: 0.0075, respectively).

Conclusion:

Both ozone applications decreased RANKL-positive cell counts, TO application decreased HIF-1-α positive cells counts, and SO application was found to be more effective in reducing ABL compared to control group.

Effectiveness of the adjunctive use of ozone and chlorhexidine in patients with chronic periodontitis

Background

Scaling and root planning (SRP) is the gold standard approach for treatment of chronic periodontitis but used alone it may not be effective in removing periodontal pathogens from sites where access is poor.

Objective

To evaluate and compare the clinical and microbiological efficacy of ozone and chlorhexidine (CHX) as an adjunct to SRP in patients with chronic periodontitis.

Methods

Twenty-five patients with generalized moderate to severe chronic periodontitis with presence of at least one site in each quadrant with a probing depth ≥5 mm were recruited. In a split mouth study design, two quadrants were randomly allocated to the SRP and ozone therapy and the remaining two quadrants to SRP and CHX therapy. Plaque index (PI), Gingival index (GI), probing depth (PD), clinical attachment loss (CAL) were assessed. Subgingival plaque samples were obtained for assessment of Aggregatibacter actinomycetemcomitans (Aa) and Porphyromonas gingivalis (Pg).

Results

Both groups demonstrated significant intragroup reduction in PI, GI, PD, CAL, Pg count and Aa count from baseline to 3 months follow-up. There were no significant differences between two groups for any of the parameters.

Conclusion

Ozonated olive oil can be used as an adjunctive subgingival irrigant in patients with chronic periodontitis.

Cytotoxicity evaluation of a new ozonized olive oil

Objective:

The cytocompatibility of a new ozonized olive oil toward immortalized human gingival fibroblasts (HGFs) was evaluated and compared with two common antimicrobial agents based on chlorhexidine digluconate (CHX).

Materials and Methods:

The cytocompatibility of the samples was tested on immortalized HGF-1 cells by 3-(4, 5-dimethyl thiazolyl-2)-2,5-diphenyltetrazolium bromide (MTT) assay. The cells were incubated for 2 or 24 h with increasing dilution of ozonized olive oil or CHX agents. The percentage of viable cells was calculated relative to control cells set to 100%.

Results:

The ozonized olive oil is cytocompatible, and the viability values of the cells treated for 2 or 24 h with increasing concentrations of ozonized olive oil were significantly higher (P < 0.01) compared with the values obtained using CHX.

Conclusions:

The present data demonstrate that due to its cytocompatibility, the new ozonized olive oil could be considered an alternative antibacterial agent.

Local drug delivery systems in the management of periodontitis: A scientific review

Periodontitis (PD) is a microbial disease of tooth supporting tissues that results in progressive destruction of surrounding soft and hard tissues with eventual tooth mobility and exfoliation. Perioceutics, which includes the delivery of therapeutic agents via systemic and local means as an adjunct to mechanical therapy has revolutionized the arena of periodontal therapy. Selection of a right antimicrobial agent with appropriate route of drug administration is the key to successful periodontal therapy. Irrigating systems, fibers, gels, strips, films, microparticles, nanoparticles and low dose antimicrobial agents are some of the local drug delivery systems (LDDS) available in the field, which aims to deliver antimicrobial agents to sub-gingival diseased sites with minimal or no side-effects on other body sites. The present review aim to summarize the current state-of-the-art technology on LDDS in periodontal therapy ensuring the the practitioners are able to choose LDD agents which are custom made for a specific clinical condition.

The effects of ozone therapy on periodontal therapy: A randomized placebo-controlled clinical trial

OBJECTIVES

The aim of this randomized split-mouth clinical trial was to evaluate the effects of ozone therapy on clinical and biochemical parameters of moderate to severe generalized periodontitis patients after non-surgical periodontal therapy.

METHODS

A total of 36 moderate to severe generalized periodontitis patients were included in the study. The patients were systemically healthy and 18 to 64 years of age. Periodontal parameters, including plaque index (PI), gingival index (GI), probing depth (PD), percentage of bleeding on probing, percentage of pockets deeper than 5 mm and clinical attachment level (CAL), and percentage of ≥3 mm CAL, were evaluated at baseline and 3 months following periodontal therapy. All participants were treated non-surgically. Topical gaseous ozone was applied into periodontal pockets twice a week for 2 weeks during active periodontal therapy. Gingival crevicular fluid pentraxin-3 (PTX-3), interleukin-1β (IL-1β), and high sensitivity C-reactive protein (Hs-CRP) were evaluated. All statistical data were analyzed using SPSS software.

RESULTS

Total of 36 participants completed the study (18 males, 18 females). PI, GI, PD, percentage of bleeding on probing, percentage of pockets deeper than 5 mm and CAL, and percentage of ≥3 mm CAL were improved, and there were no significant differences between the two sides. All inflammatory parameters, PTX-3, Hs-CRP, and IL-1, were reduced at 3-month follow-up. Only the decrease in PTX-3 levels between baseline and 3-month follow-up was statistically significant.

CONCLUSIONS

Ozone therapy did not have any additional effect on periodontal parameters. All cytokines were reduced after periodontal therapy. Only PTX-3 levels were significantly lower at ozone sites compared to those at the control sites.

Evaluating clinical and laboratory effects of ozone in non-surgical periodontal treatment: a randomized controlled trial

OBJECTIVE

This study aims to evaluate the clinical and biochemical (oxidative stress and pro-inflammatory mediators) effects of the gaseous ozone use accompanied by scaling and root planning (SRP) in periodontal treatment.

MATERIAL AND METHODS

The study population consisted of 40 patients with chronic periodontitis (CP) randomly sorted into two groups of 20. The experimental group received SRP plus 3 watts gaseous ozone in two separate applications five days apart, whereas the control group received SRP plus placebo. Clinical periodontal parameters were assayed and saliva samples were taken before the initial and one month after the second treatment. Periodontal examination assessed plaque index (PI), gingival index (GI), probing depth, and clinical attachment level (CAL). Total antioxidant status (TAS), total oxidant status (TOS), nitric oxide (NO), 8-hydroxy-2'-deoxyguanosine (8-OHdG), myeloperoxidase (MPO), glutathione (GSH), malondialdehyde (MDA), and transforming growth factor-beta (TGF-β) levels were evaluated from saliva samples.

RESULTS

Changes following treatment in PI, GI, probing depth, and CAL scores were similar for both groups (p>0.05). Of note, TGF-β levels were observed to be higher in the treatment group than in controls (p<0.05). Changes in 8-OHdG, TAS, TOS, NO, MPO, GSH and MDA levels, however, were not significantly different between groups (p>0.05).

CONCLUSION

The findings of this study indicate that SRP plus gaseous ozone versus SRP alone does not correlate to a significant improvement in periodontal recovery.

Evaluation of the antibacterial activity of a new ozonized olive oil against oral and periodontal pathogens

Background

In the present study, the antimicrobial properties of a new ozonized olive oil (O-zone gel) against oral and periodontal pathogens will be evaluated and compared with that of common CHX-based agents.

Material and Methods

O-zone gel was compared with two agents based on chlorhexidine digluconate (CHX): Corsodyl Dental Gel and Plak Gel. A. actinomycetemcomitans, P. intermedia and S. mutans, were selected and the antibacterial capability of the compounds was tested by using direct contact agar diffusion test (DCT) and minimum inhibitory concentration (MIC) and minimum bactericidal concentration (MBC) evaluations. Differences between specific means were analyzed by a one-way analysis of variance (ANOVA). Group means were compared using a one-way ANOVA and Tukey’s test (P<0.05).

Results

O-zone gel reported inhibition zones which correspond to 33% and 43% of that achieved by the CHX agents. No inhibition of bacterial growth (MIC) on the Gram-positive strain by using O-zone gel was found and no antimicrobial effect (MBC) was observed by using O-zone gel on both Gram-negative and -positive strains.

Conclusions

The new ozonated oil was a relatively moderate antiseptic. Gram-negative bacteria proved to be more sensitive to ozonized olive oil than Gram-positive ones. The ozonized olive oil demonstrated a lower antibacterial activity if compared to the CHX-based agents tested.

Key words:Agar diffusion test, antibacterial activity, direct contact test, ozone, ozonized olive oil.

Management of denture-related traumatic ulcers using ozone

STATEMENT OF PROBLEM

Management of denture-related traumatic ulcers using ozone may improve tissue healing and reduce patient pain and discomfort.

PURPOSE

The purpose of this clinical investigation was to assess the efficacy of ozone in the treatment of denture-related traumatic ulcers.

MATERIAL AND METHODS

Seventy-five participants (study group) with denture-related traumatic ulcers were evaluated in this blinded, controlled cohort observational investigation. A control group (n=75) of participants with denture-related traumatic ulcers who matched the study group in sex and age were also recruited. Ulcers were treated with ozone gas for 60 seconds in the study group and with air for 60 seconds in the control group. Pain levels were evaluated by means of a visual analog scale (VAS), and ulcer sizes were measured in each participant at experiment baseline and each day for 15 days. Ulcer duration was established by calculating the period it took to completely heal and disappear. Major outcome measurements were ulcer duration, ulcer size, and levels of pain.

RESULTS

Ulcer size decreased from day 2 in the study group (after ozone application) (P≤.01) and from day 4 in the controls (P≤.001). Recorded pain levels decreased from the first day soon after ozone application in the study group (P≤.001) and from day 3 in the controls (P<.001). Ulcer duration, ulcer size from day 3 to day 10, and reported pain levels from day 1 to day 10 decreased more in the study group (P≤.004).

CONCLUSIONS

Exposure of denture-related traumatic ulcers to 60 seconds of ozone gas was associated with better ulcer healing and decreased pain levels, ulcer size, and ulcer duration.

Ozone application as adjunctive therapy in chronic periodontitis: Clinical, microbiological and biochemical aspects

Background/purpose

The application of ozone as an adjunctive treatment represents a new approach in the management of chronic periodontitis. The purpose of this study was to evaluate the clinical, biochemical and microbiological efficacy of ozone treatment as an adjunct to scaling and root planing (SRP) in generalized chronic periodontitis (GCP) patients.

Materials and methods

Eighteen patients (9 males and 9 females; aged from 28 to 47 years, mean age of 40 ± 6.51 years) with GCP were recruited in the study. In a split mouth design, two quadrants in each patient were randomly allocated to SRP-alone or SRP-ozone therapy (SRP + OT) groups by coin toss method. Subgingival plaque and gingival crevicular fluid (GCF) samples were collected at baseline, following 1st and 3rd months. The clinical parameters were monitored at baseline and after 3 months. Microbiological parameters were analyzed by quantitative-PCR and GCF biomarkers were determined by ELISA. Results were analyzed statistically.

Results

Statistically significant improvements in all clinical parameters were accompanied by a reduction in microbiological and biochemical parameters in both treatment groups. SRP treatment resulted in a significant reduction of Porphyromonas gingivalis (Pg) at 1st month and Tannerella forsythia (Tf) and Prevotella intermedia (Pi) at 3 months. Following SRP treatment the interleukin (IL)-8 levels were significantly reduced at month 1. There were no significant differences between two treatments for any of the parameters.

Conclusion

Within the limitations of this study, adjunctive ozone therapy did not provide additional benefits to clinical, microbiological and biochemical parameters over SRP in chronic periodontitis patients.

The effects of ozone therapy as an adjunct to the surgical treatment of peri-implantitis

PURPOSE

The decontamination procedure is a challenging aspect of surgical regenerative therapy (SRT) of peri-implantitis that affects its success. The purpose of the present study was to determine the impact of additional topical gaseous ozone therapy on the decontamination of implant surfaces in SRT of peri-implantitis.

METHODS

A total of 41 patients (22 males, 19 females; mean age, 53.55±8.98 years) with moderate or advanced peri-implantitis were randomly allocated to the test group (ozone group) with the use of sterile saline with additional ozone therapy or the control group with sterile saline alone for decontamination of the implant surfaces in SRT of peri-implantitis. Clinical and radiographic outcomes were evaluated over a period of 12 months.

RESULTS

At the 12-month follow-up, the plaque and gingival index values were significantly better in the ozone group (P<0.05). Probing depth decreased from 6.27±1.42 mm and 5.73±1.11 mm at baseline to 2.75±0.7 mm and 3.34±0.85 mm at the end of the 12-month observation period in the ozone and control groups, respectively. Similarly, the clinical attachment level values changed from 6.39±1.23 mm and 5.89±1.23 mm at baseline to 3.23±1.24 mm and 3.91±1.36 mm at the 12-month follow-up in the ozone and control groups, respectively. According to the radiographic evidence, the defect fill between baseline and 12 months postoperatively was 2.32±1.28 mm in the ozone group and 1.17±0.77 mm in the control group, which was a statistically significant between-group difference (P<0.05).

CONCLUSIONS

Implant surface decontamination with the additional use of ozone therapy in SRT of peri-implantitis showed clinically and radiographically significant. Trial registry at ClinicalTrials.gov, NCT03018795.

The effects of ozone application on genotoxic damage and wound healing in bisphosphonate-applied human gingival fibroblast cells

OBJECTIVES

Medication-related osteonecrosis of the jaws (MRONJ) is an extremely therapy-resistant disease involving the jaws especially following bisphosphonate treatment. Bisphosphonates accumulate in bone in concentrations sufficient to be directly toxic to the oral epithelium. Current therapeutic options are inadequate for the prevention and treatment of MRONJ. The aim of this study was to investigate effects of ozone gas plasma therapy on wound healing in bisphosphonate-applied human fibroblasts.

MATERIAL AND METHODS

Human primary gingival fibroblasts were cultured. Cytotoxic concentrations (IC50) of bisphosphonates (pamidronate (PAM), alendronate (ALN), and zoledronate (ZOL)) were determined by MTT test. A 60 μg/μl for 30 s of ozone gas plasma application was performed to all experimental culture flasks after drug treatment at 24-h intervals as 3 s/cm². Genotoxic damages were evaluated by comet assay and wound healing was determined by in vitro scratch assay.

RESULTS

PAM, ALN, and ZOL applications caused genotoxic damage on primary human gingival fibroblast DNA. Ozone gas plasma therapy significantly decreased the genotoxic damage (p < 0.05), and this application provided 25, 29, and 27% less genotoxic damage in order of ALN, PAM, and ZOL groups. Ozone gas plasma therapy significantly increased wound healing rates both in postsurgical 24th and 48th hours for all doses of experimental drug groups (p < 0.05).

CONCLUSION

The ozone gas plasma application decreased genotoxic damage effect of bisphosphonate usage while improved the wound closure rate on human gingival fibroblasts.

CLINICAL RELEVANCE

Ozone gas plasma therapy may be helpful in prevention of gingival healing delay in MRONJ pathogenesis especially when applied simultaneously with surgical intervention.

AMPK activation by peri-sciatic nerve administration of ozone attenuates CCI-induced neuropathic pain in rats

Neuropathic pain is a debilitating clinical condition with few efficacious treatments, warranting development of novel therapeutics. Ozone is widely used as an alternative therapy for many different pain conditions, with exact mechanisms still elusive. In this study, we found that a single peri-sciatic nerve injection of ozone decreased mechanical allodynia and thermal hyperalgesia, and normalized the phosphorylation of protein kinase C γ, N-methyl-D-aspartate receptor, and extracellular signal-regulated kinase in a chronic constriction injury (CCI) model in rat sciatic nerve. Meanwhile, ozone significantly suppressed CCI-induced activation of spinal microglia. More importantly, the anti-nociceptive effect of ozone depended on the activation of 5'-adenosine monophosphate (AMP)-activated protein kinase (AMPK), which was proved by the fact that the phosphorylated AMPK level increased during the ozone therapy and AMPK antagonist abolished the effect of ozone in vivo and in vitro. In addition, direct injection of AMPK agonist could replicate the anti-nociceptive effect of ozone in CCI rats. In conclusion, our observations indicate that peri-sciatic nerve injection of ozone activates AMPK to attenuate CCI-induced neuropathic pain.

Effects of combining ozone and hydrogren peroxide on tooth bleaching: A clinical study

OBJECTIVES

The purpose of this study was to evaluate the efficiency of bleaching after combining ozone and 38% H2O2 in comparison to the sole use of 38% H2O2.

METHODS

Consecutive 26 participants (13 males and 13 females) were recruited into this study. They were randomly allocated into 2 groups (n=13 for each group). In group 1 (test group); the participants' upper anterior teeth were treated with 38% H2O2 for 20min then the teeth were exposed to ozone for 60s (healOzone(®) X4, KaVo Dental, Biberach, Germany). In group 2 (controls); the upper anterior teeth were treated with 20min of 38% H2O2 only. The shade of teeth was evaluated by recording the L* a* b* values and Vita Classic shades at study baseline and after bleaching in both groups. The statistically significant changes were set at P≤0.05.

RESULTS

Tooth sensitivity and teeth shades were comparable between groups at study baseline (p>0.05). Controls reported more tooth sensitivity following bleaching (p<0.001). Teeth achieved better Vita shades, higher L* values (lighter shades), and lower a* and b* values (lighter shades) after bleaching in both groups (P≤0.05). However, teeth bleached with H2O2 and ozone achieved better Vita shades, higher L* values and lower a* values (lighter shades) than those bleached with H2O2 alone (p<0.001). Changes in b* values were not significantly different between groups.

CONCLUSIONS

Bleaching with 38% H2O2 for 20min followed by 60s of ozone application would result in teeth with lighter shades than bleaching with 38% H2O2 alone.

Ozone treatment of recurrent aphthous stomatitis: a double blinded study

This study aimed to evaluate the use of ozone to treat recurrent aphthous stomatitis (RAS). Consecutive sixty-nine participants with RAS were recruited into this non-randomized double blind, controlled cohort observational study (test group). A control group of 69 RAS patients who matched test group with age and gender was recruited. RAS lesions in test group were exposed to ozone in air for 60 seconds while controls received only air. Ulcer size and pain were recorded for each participant at baseline and daily for 15 days. Ulcer duration was determined by recording the time taken for ulcers to disappear. The main outcome measures were pain due to the ulcer, ulcer size and ulcer duration. 138 RAS participants (69 participants and 69 controls) were analyzed. Ulcer size was reduced starting from the second day in test group and from the fourth day in controls (p ≤ 0.004). Pain levels were reduced starting from the first day in the test group and from the third day in controls (p ≤ 0.001). Ulcer duration, ulcer size after day 2 and pain levels were more reduced in the test group. In conclusion, application of ozone on RAS lesions for 60 seconds reduced pain levels and enhanced ulcers' healing by reducing ulcers' size and duration.

Effects of Ozone Therapy on the Early Healing Period of Deepithelialized Gingival Grafts: A Randomized Placebo-Controlled Clinical Trial

BACKGROUND

This study evaluates the effects of ozone therapy (OT) on the early healing period of deepithelialized gingival grafts (DGG) placed for non-root coverage gingival augmentation by laser Doppler flowmetry (LDF).

METHODS

Thirty-three patients were assigned to study groups: 1) test: DGG + OT; or 2) control group: DGG alone. Thirty patients completed the study. Ozone was applied on DGGs placed in the recipient bed and donor site immediately after surgery and at days 1 and 3 post-surgery. Blood perfusion in the recipient site was measured by LDF on the day of surgery and at 1, 2, 3, 6, 8, 10, and 13 days after surgery. Quality of life (assessed by the Oral Health Impact Profile-14) and pain at donor/recipient sites (assessed by visual analog scale) were also investigated.

RESULTS

Increase in blood perfusion units in the test group was significantly higher than control group at 1, 2, 3, 6, and 8 days post-surgery (P <0.001). Significant differences occurred between test and control groups in terms of visual analog scale values during the first week post-surgery for both donor and recipient sites (P <0.05). The ozone-treated group showed significantly higher quality of life than control group on postoperative day 6 (P = 0.002).

CONCLUSIONS

OT enhanced blood perfusion units in the first postoperative week. This outcome is also consistent with improvement in wound healing, accompanied by an increase in quality of life and decrease in postoperative pain in the test group.