Evaluation of Postoperative Effects of Using Ozonated Water as an Irrigant on Soft and Hard Tissues Surrounding Dental Implants: A Randomized Controlled Clinical Trial

Aim To evaluate the short-term and long-term postoperative effects of ozonated water when used as an irrigant in terms of postoperative pain, healing, and implant stability when compared to normal saline irrigation during implant surgery, both carried out using conventional drilling protocol. Methods A total of 34 implants were placed in 17 patients, two implants in each patient, one implant using normal saline as an irrigant and another one using ozonated water as an irrigant during the surgical procedure of implant site osteotomy. Postoperative pain was assessed after 48 hours of the surgical procedure using the visual analog scale (VAS). Soft tissue healing was assessed after eight days using the tissue healing index. Osseointegration was checked by measuring the primary stability at the moment of implant placement and comparing it to the secondary stability measured three months after the implant placement. These stability values (ISQ) were obtained using resonance frequency analysis (RFA). Results The VAS scores for the control group (Group A) after 48 hours were 71.76±5.57 and for the experimental group (Group B) after 48 hours were 47.64±5.33 so mean values in the experimental group were significantly lower as compared to that in the control group (p<0.001). The mean healing index score for the control group (Group A) was 3.35±0.49 and the mean healing index score for the experimental group (Group B) was 4.64±0.49 so the mean values of tissue healing index in the experimental group were significantly higher as compared to that in the control group (p<0.001). The increase in stability value over the period of three months is 5.83 ISQ in the control group while the increase in stability value over the period of three months is 7.06 ISQ in the experimental group. The difference although not statistically significant shows a slight increase in stability in the experimental group as compared to that of the control group. Conclusion Ozone water irrigation at implant site osteotomy reduced postoperative pain and accelerated the tissue wound healing but the significant effect on osseointegration could not be determined.

Cyclosporine a inhibits bone regeneration and induces bone loss in a rat model

Cyclosporine A (CSA) is an immunosuppressant that has been extensively studied for its side effects on inhibiting osseointegration of titanium implants. However, the impact of CSA on bone healing in postmenopausal osteoporosis remains unknown. Therefore, this study aimed to investigate the effect of CSA on bone repair in an ovariectomized (OVX) rat model through both in vitro and in vivo experiments. We examined the interventions of CSA on osteoblast progenitor cells MC3T3-E1 and assessed their effects on biological function using RT-qPCR, CCK-8 assay, alizarin red staining, and alkaline phosphatase staining. Furthermore, we evaluated the effects of CSA on bone regeneration and bone mass in both OVX rat models and femoral diaphysis bone defect models. The results from the CCK-8 experiment indicated a positive influence of experimental doses of CSA on osteogenic differentiation of MC3T3-E1 cells. ALP expression levels and calcified nodules were also evaluated, suggesting that CSA intervention promoted osteogenic differentiation in MC3T3-E1 cells. Additionally, specific gene expressions including OPN, Runx-2, OC, and Col1a1 were up-regulated after CSA intervention. Biomechanical parameters aligned with histological analysis as well as micro-CT scans confirmed worse bone microstructure and strength following CSA intervention. Our findings preliminarily suggest that whether it is normal or osteoporotic bones, CSA has adverse effects on bone health which are associated with elevated-bone turnover.

Comparative Evaluation of Normal Saline Gel and Ozone Therapy on Soft and Hard Tissue Health in Dental Implant Surgery

AIMS

To comparatively evaluate the effect of normal saline gel and ozonated saline-ozonated gel (ozone therapy) on pain, inflammation, soft tissue, and crestal bone loss in dental implant surgery.

METHODS AND MATERIAL

Forty adult patients scheduled to undergo implant were randomized into two groups: Twenty patients (n = 20) received ozone therapy and controls (n = 20) received normal saline and gel during implant placement. Inflammation and pain were noted at days 1 and 7 and 3 month intervals by estimating C-reactive protein (CRP) levels and assessing visual analogue scale (VAS) scores. At 3 months, soft tissue outcomes were noted in terms of plaque index, gingival index, and pocket depth, while crestal bone loss was noted via a radiograph.

RESULTS

Mean CRP levels were significantly higher in the control group as compared to that in the case group on day 1 and day 7 follow-ups (P < 0.05). Mean VAS scores for pain were also lower in the case group as compared to the control group at all follow-ups, but the difference was significant statistically only at day 1 (P = 0.061). The plaque index was significantly lower in the case group as compared to the control group (P = 0.011) at final follow-up. No significant difference between two groups was observed for crestal bone loss.

CONCLUSIONS

Ozone therapy during implant placement was effective in reduction of pain, systemic inflammation, and plaque deposition in dental implant patients.

Enhancing the Antimicrobial Effect of Ozone with Mentha piperita Essential Oil

This study aimed to obtain and analyse Mentha piperita essential oil (MpEO) for the prospect of being used as an enhancement agent for the antimicrobial potential of ozone against gram-positive and gram-negative bacteria and fungi. The research was done for different exposure times, and it gained time-dose relationships and time-effect correlations. Mentha piperita (Mp) essential oil (MpEO) was obtained via hydrodistillation and further analysed by using GC-MS. The broth microdilution assay was used to determine the strain inhibition/strain mass growth by using spectrophotometric optical density reading (OD). The bacterial/mycelium growth rates (BGR/MGR) and the bacterial/mycelium inhibition rates (BIR/MIR) after ozone treatment in the presence and absence of MpEO on the ATTC strains were calculated; the minimum inhibition concentration (MIC) and statistical interpretations of the time-dose relationship and specific t-test correlations were determined. The effect of ozone on the following tested strains at maximum efficiency was observed after 55 s of single ozone exposure, in order of effect strength: S. aureus > P. aeruginosa > E. coli > C. albicans > S. mutans. For ozone with the addition of 2% MpEO (MIC), maximum efficacy was recorded at 5 s for these strains, in order of effect strength: C. albicans > E. coli > P. aeruginosa > S. aureus > S. mutans. The results suggest a new development and affinity regarding the cell membrane of the different microorganisms tested. In conclusion, the use of ozone, combined with MpEO, is sustained as an alternative therapy in plaque biofilm and suggested as helpful in controlling oral disease-causing microorganisms in medicine.

Effects of Drugs and Chemotherapeutic Agents on Dental Implant Osseointegration: A Narrative Review

BACKGROUND

Dental implants have been one of the most popular treatments for rehabilitating individuals with single missing teeth or fully edentulous jaws since their introduction. As more implant patients are well-aged and take several medications due to various systemic conditions, clinicians should take into consideration the possible drug implications on bone remodeling and osseointegration.

OBJECTIVE

The present study aims to examine and review some desirable and unwelcomed implications of medicine on osseointegration.

METHODS

A broad search for proper relevant studies was conducted in four databases, including Web of Science, Pubmed, Scopus, and Google Scholar.

RESULTS

Some commonly prescribed medicines, such as nonsteroidal anti-inflammatory drugs (NSAIDs), glucocorticoids, proton pump inhibitors (PPIs), selective serotonin reuptake inhibitors (SSRIs), anticoagulants, metformin, and chemotherapeutic agents, may jeopardize osseointegration. On the contrary, some therapeutic agents, such as anabolic, anti-catabolic, or dual anabolic agents may enhance osseointegration and increase the treatment's success rate.

CONCLUSION

Systemic medications that enhance osseointegration include mineralization promoters and bone resorption inhibitors. On the other hand, medications often given to the elderly with systemic problems might interfere with osseointegration, leading to implant failure. However, to validate the research, more human studies with a higher level of evidence are required.

Ozonized Water Administration in Peri-Implant Mucositis Sites: A Randomized Clinical Trial

Peri-implant mucositis represents an inflammatory lesion of the mucosa surrounding an endosseous implant, without the loss of the supporting peri-implant bone. Considering its reversible nature, every effort should be made to contrast it, thus avoiding the eventual progression towards peri-implantitis. The aim of the present randomized clinical trial is to evaluate the efficacy of the ozonized water against peri-implant mucositis. A total of 26 patients diagnosed for this latter clinical condition were randomly divided according to the professional oral hygiene protocol performed on the pathological sites at baseline, at T1 (1 month), and T2 (2 months). Group 1 underwent an ozonized water administration (experimental treatment), whereas Group 2 underwent a pure water one (control treatment). Both administrations were performed with the same professional irrigator (Aquolab® professional water jet, Aquolab s.r.l. EB2C S.r.l., Milano, Italy) with no differences in color or taste between the two substances delivered. At each appointment, the following indexes were assessed: the Probing Pocket Depth (PPD), Plaque Index (PI), Bleeding on Probing (BoP), and Bleeding Score (BS). As regards intragroup differences, in Group 1 ozonized water significantly and progressively reduced all the clinical indexes tested, except for PI in the period T1–T2, whereas no significant differences occurred within the control group. Despite this, no significant intergroup differences were generally detected between the two treatments. Accordingly, the role of ozone for the management of peri-implant mucositis deserves to be further investigated.

Dental implant procedures in immunosuppressed organ transplant patients: a systematic review

During the last decades, the number of immunosuppressed organ transplant patients has increased consistently. Nevertheless, immunosuppression has been discussed as a contraindication for dental implant procedures for many years. Hence, the purpose of this systematic review was to assess the survival rate and outcomes of dental implants after solid organ transplantation. An electronic and manual literature search was conducted up to March 2021. Publications describing dental implants placed in patients after organ transplantation were included without any limitations regarding study design or date of publication. Ten articles met the inclusion criteria, leading to a sample of 93 patients with 249 implants. Implant survival rates were 100% over a mean follow-up of 60 months. In every case, implant surgery was performed under antibiotic coverage. No major medication-related complications were reported. Despite the limited amount of evidence in the literature, implant procedures seem to be a safe treatment option in immunosuppressed organ transplant patients. The observance of appropriate treatment protocols including a strict maintenance programme seems to be crucial for the long-term success of such treatments. However, stringent data regarding various influencing factors such as the prevalence of peri-implantitis are still missing.

An evaluation of the effect of ozone therapy on tissues surrounding dental implants

BACKGROUND

Dental implant surgery despite its growing popularity poses several challenges like include tissue inflammation, pain discomfort and tissue injury.

OBJECTIVE

To evaluate the effect of ozone therapy on inflammation, pain and wound healing after implant surgery.

METHODS

A clinical study was conducted on 60 systematically healthy patients- 30 patients treated with ozone (Experimental group) and 30 patients without ozone treatment (control group). In the control group osteotomy procedure was performed with saline irrigation and in the experimental group irrigation was done with ozonated water at 25 µg/mL concentration, along with ozone gas. Clinical assessment was done by evaluating C-reactive Protein (CRP) for inflammation, pain using Visual Analogue Scale (VAS) score and tissue wound healing using wound healing index. Side effects, if any, were noted.

RESULTS

Postoperative increment in CRP levels was 0.10 and 0.63 mg/dl in Experimental and control groups respectively (p < 0.001). At 24-hr, 48-hr and 7 day post-operative intervals mean VAS scores for pain were significantly higher in Control group as compared to that in Experimental Group (p < 0.001). At day 7, mean VAS scores for pain were 3.50 ± 0.63 and 37.70 ± 4.17 in Experimental and Control groups respectively (p < 0.001). Mean tissue healing indices were significantly higher on Day 7 and Day 14 in Experimental Group (4.23 ± 0.43 and 4.97 ± 0.18) as compared to that in control group (3.07 ± 0.45 and 4.03 ± 0.18) (p < 0.001). No potential side effects were noted in either of two groups.

CONCLUSION

Ozone therapy accelerated the tissue wound healing, minimized tissue inflammation and decreased pain.

Ozone therapy in dentistry: from traditional applications towards innovative ones. A review of the literature

Ozone (03) is a natural gas deriving from dioxygen (02) and acting as a strong oxidant. Despite this characteristic, low doses of ozone can be beneficial for the organism due to the antioxidant response implemented by this latter. Accordingly, since the 19th century, several therapeutic applications have been proposed in medicine, but even dental pathologies can benefit from the use of this substance. In particular, the introduction of ozone therapy in dentistry dates to 1930 when it was proposed as a disinfectant and wound-healing agent. Nowadays, it is known as an antioxidant, anti-inflammatory, immunomodulatory, anti-hypoxic, biosynthetic and antimicrobial agent. The main forms of ozone administration are three (gaseous ozone, ozonated water and ozonated oils) but its therapeutic indications almost cover every field of dentistry. The aim of the present review is first to describe the main traditional uses of ozone in dentistry, and, subsequently, to present the innovative applications proposed both in dental and orthopaedic implantology.

Osseointegration Pharmacology: A Systematic Mapping Using Artificial Intelligence

Clinical performance of osseointegrated implants could be compromised by the medications taken by patients. The effect of a specific medication on osseointegration can be easily investigated using traditional systematic reviews. However, assessment of all known medications requires the use of evidence mapping methods. These methods allow assessment of complex questions, but they are very resource intensive when done manually. The objective of this study was to develop a machine learning algorithm to automatically map the literature assessing the effect of medications on osseointegration. Datasets of articles classified manually were used to train a machine-learning algorithm based on Support Vector Machines. The algorithm was then validated and used to screen 599,604 articles identified with an extremely sensitive search strategy. The algorithm included 281 relevant articles that described the effect of 31 different drugs on osseointegration. This approach achieved an accuracy of 95%, and compared to manual screening, it reduced the workload by 93%. The systematic mapping revealed that the treatment outcomes of osseointegrated medical devices could be influenced by drugs affecting homeostasis, inflammation, cell proliferation and bone remodeling. The effect of all known medications on the performance of osseointegrated medical devices can be assessed using evidence mappings executed with highly accurate machine learning algorithms.

Ozonized Gel Against Four Candida Species: A Pilot Study and Clinical Perspectives

Ozone therapy can display a wide range of clinical beneficial effects, including antimicrobial, immune-stimulant, analgesic, anti-hypoxic actions. However, there is still a paucity of data regarding the ozone fungicide activity. Oral Candida is the most common fungal infection in the mouth among denture wearers and people with weakened immune systems. In the case of generalized candidiasis or immunocompromised patients, systemic therapy is needed, while localized infections are treated with topic medications. However, many Candida strains are resistant to antifungal drugs. The aim of this preliminary analysis is to evaluate the antimycotic efficacy of a new ozonided oil (GeliO₃), as a possible terapeutic alternative in local treatments of these infections, compared to chlorhexidine digluconate (Plak gel®). Chlorhexidine is a chemical synthesis disinfectant with a broad-spectrum antiseptic action, active against bacteria and fungi. Antimycotic activity was tested against the following four Candida species: C. albicans, C. parapsilosis, C. glabrata, C. tropicalis, through an agar diffusion method. No significant differences were found between the growth inhibition zone diameters of the ozonized gel and chlorhexidine. The results indicated that the ozonized gel may help to combat Candida infections. Moreover, useful applications could be used to counteract Candida colonization of endosseous implants.

Ozonated Oils as Antimicrobial Systems in Topical Applications. Their Characterization, Current Applications, and Advances in Improved Delivery Techniques

The search for a wide spectrum of antimicrobial agents that can avoid resistance while maintaining reasonable side effects has led to ozonated oils experiencing an increase in scientific interest and clinical applications. The treatment of vegetable oils with ozone leads to the creation of a reservoir of ozone that slowly releases into the skin thanks to the fact that ozone can be held as ozonides of unsaturated fatty acids. Interest in the use of ozonated oils has meant that several ozonated-vegetable-oil-containing products have been commercialized as cosmetic and pharmaceutical agents, and in innovative textile products with antibacterial activity. New approaches to the delivery of ozonated oils have very recently appeared in an attempt to improve their characteristics and reduce drawbacks, such as an unpleasant odor, high viscosity and undesired effects on skin, including irritation and rashes. The present review focuses on the current status of delivery agents that use ozonated oils as antimicrobial agents in topical (dermal, skin, and soft tissues) treatments. Challenges and future opportunities for these delivery systems will also be discussed.

Ozone- A Biological Therapy in Dentistry- Reality or Myth?????

The usage of ozone in dentistry has been proposed because of its antimicrobial, disinfectant, biocompatibility and healing properties. In the last decade a number of therapeutic protocols with ozone have been developed to address common dental infections associated with periodontal disease, RCT and caries. Despite these advantages, therapeutic ozone's application in dentistry is limited because of its possible side effects. Hence, dental practitioners need to know the proper usage of ozone therapy that can provide better patient care and considerably cut down the time and cost of the treatment.