Role of intra-articular ozone gas injection in the management of internal derangement of the temporomandibular joint

Effect of ozone therapy on the modulation of inflammation and on new bone formation in critical defects of rat calvaria filled with autogenous graft

OBJECTIVE

The aim of this study was to evaluate the effect of ozone therapy on new bone formation and inflammation modulation in defects of rat calvaria filled with autogenous bone.

MATERIAL AND METHODS

Critical size defects were created in the calvaria of 24 male Wistar rats. The animals were randomly divided into four groups according to the treatment: G1: clot; G2: clot and covered with xenogenic membrane; G3: particulate autogenous bone graft; G4: autogenous bone graft and application of 3 mL O₂/O₃ gas mixture (10 µg/ml). The defects were filled immediately after surgery with a bilateral retroauricular application, in the region immediately above the incision. After 21 days, the animals were euthanized, and the samples were processed for morphometric evaluations designed to measure both the intensity of the inflammatory infiltrate, and the presence of new bone formation in the defect.

RESULTS

The results showed a lower inflammation score and higher mean of newly formed bone in the region of the defect for the group associated with ozone therapy (G4). The bone formed in the region of the defect could be observed as being more lamellar and mineralized in the case of associated ozone therapy.

CONCLUSION

Ozone therapy represents a promising adjuvant therapy to accelerate tissue regeneration.

Potential Clinical Applications of Ozone Therapy in Dental Specialties-A Literature Review, Supported by Own Observations

Apart from conventional treatment, dentists are increasingly relying on physical therapy modalities in their clinical practice. The aim of this literature review is to analyze the clinical relevance and potential uses of ozone in modern dentistry. The research question is geared towards detailing the multiple potential applications of ozone therapy in a range of dental specialties. Based on the available literature, accessed via the PubMed, Google Scholar, Scopus, and EBSCO databases, a detailed search of the electronic literature was performed for 2001-2022. Eligible studies were chosen according to inclusion and exclusion criteria, using keywords: ozone, ozone therapy, therapeutic applications, oxidants, dental disinfectants, oral medicine, physical therapy in dentistry. Out of 834 manuscripts, 273 studies were curated. A total of 70 publications were used in the final consideration. After assessing their quality, they were analyzed to determine the relevance and potential use of ozone in the various aspects of modern dentistry. Ozone therapy is used mainly as an adjunct to the primary clinical or pharmacological treatment. In some cases of oral mucosal disease, it has proven effective as a primary therapy. During the literature analysis, it was noted that ozone therapy in dentistry is a subject of ongoing research, and the results are not always consistent. The multitude of studies in the literature on the applications of ozone in dentistry reflects the search for its undiscovered physical therapeutic potential.

The Efficacy of Ozonized Water Versus Ringer Lactate Arthrocentesis for the Treatment of Temporomandibular Joint Internal Derangement

BACKGROUND

Temporomandibular disorders are musculoskeletal conditions characterized by facial pain and impaired temporomandibular joint function, limited mouth opening, joint and muscular pain, and noises during mandibular movements are some of the most common symptoms. The most frequent cause of temporomandibular joint dysfunction is internal derangement (ID), which refers to an alteration in the normal pathways of motion of the joint that largely involves the function of the articular disc, therefore, these alterations have been also referred to as disc derangement. Arthrocentesis is a minimally invasive technique, less expensive than surgical treatment. Adhesions are released after arthrocentesis of the upper joint space under sufficient hydraulic pressure. Intra-articular ozone gas injection is used as conservative treatment modalities for ID of the temporomandibular as it possesses anti-inflammatory, analgesic effects, enhancement the host defense mechanism and accelerates the healing process of the damaged cells.

AIM

The aim of this study was to compare the effectiveness of ozonized water against lactated ringer solution in the arthrocentesis of the temporomandibular joint.

PATIENTS AND METHODS

Sixty patients were used in this study, suffered from ID of the temporomandibular joint treated by arthrocentesis under hydraulic pressure and were allocated into 2 groups; the study group (A), which included 30 patients, managed by arthrocentesis utilizing ozonized water and the control group (B) with 30 patients also treated by the same procedure using ringer lactate solution. Visual analog scale pain scores, temporomandibular joint sounds, and maximal mouth opening were assessed preoperatively and at different intervals postoperatively.

RESULTS

The age in this study ranged from 14 to 66 years. The mean age of group A was 29.93 years with an SD of ±11.79. For group B, the mean age was 27.56 years and the SD was ±10.80, the prominent percentage in both groups was <30 years. Regarding sex, 45 patients were females, whereas the males were 15 with a ratio of 3:1. Group A registered the highest reduction in the visual analog scale at all postoperative intervals. With respect to the mouth opening, there was no significant difference in maximal mouth opening between the 2 groups after 1 week and 12 weeks in comparison with the preoperative measurements. The temporomandibular joint sounds improved in all patients in group A after 12 weeks, whereas in group B the sounds dropped to 33.3%.

CONCLUSION

The data from the present study suggested more favorable treatment outcomes for ozonized water lavage and it is a promising new treatment modality for the relief of symptoms associated with the ID of the temporomandibular joint.

Treatment of Mandibular Hypomobility by Injections into the Temporomandibular Joints: A Systematic Review of the Substances Used

INTRODUCTION

Hyaluronic acid, steroids and blood products are popularly injected into the temporomandibular joint (TMJs) to relieve pain and increase the extent of mandibular abduction. The purpose of this review is to identify other injectable substances and to evaluate them in the above-mentioned domains.

MATERIAL AND METHODS

The review included articles describing clinical trials of patients treated with intra-articular injections with or without arthrocentesis.

RESULTS

The following emerging substances were initially evaluated to be effective in treating TMJ pain and increasing the amplitude of mandibular abduction: analgesics, dextrose with lidocaine, adipose tissue, nucleated bone marrow cells and ozone gas.

DISCUSSION

Better effects of intra-articular administration are achieved by preceding the injection with arthrocentesis.

CONCLUSIONS

The most promising substances appear to be bone marrow and adipose tissue.

Oxygen-Ozone Therapy for Reducing Pro-Inflammatory Cytokines Serum Levels in Musculoskeletal and Temporomandibular Disorders: A Comprehensive Review

To date, the application of oxygen-ozone (O₂O₃) therapy has significantly increased in the common clinical practice in several pathological conditions. However, beyond the favorable clinical effects, the biochemical effects of O₂O₃ are still far from being understood. This comprehensive review aimed at investigating the state of the art about the effects of O₂O₃ therapy on pro-inflammatory cytokines serum levels as a modulator of oxidative stress in patients with musculoskeletal and temporomandibular disorders (TMD). The efficacy of O₂O₃ therapy could be related to the moderate oxidative stress modulation produced by the interaction of ozone with biological components. More in detail, O₂O₃ therapy is widely used as an adjuvant therapeutic option in several pathological conditions characterized by chronic inflammatory processes and immune overactivation. In this context, most musculoskeletal and temporomandibular disorders (TMD) share these two pathophysiological processes. Despite the paucity of in vivo studies, this comprehensive review suggests that O₂O₃ therapy might reduce serum levels of interleukin 6 in patients with TMD, low back pain, knee osteoarthritis and rheumatic diseases with a concrete and measurable interaction with the inflammatory pathway. However, to date, further studies are needed to clarify the effects of this promising therapy on inflammatory mediators and their clinical implications.

Treatment of temporomandibular joint disc displacement using arthrocentesis combined with injectable platelet rich fibrin versus arthrocentesis alone

Background/purpose

Temporomandibular joint disc displacement is the most frequently reported temporomandibular disorder that may severely impair quality of life and can be challenging to treat. This study aimed to evaluate and compare the efficiency of intra-articular injection of injectable platelet rich fibrin (i-PRF) following arthrocentesis or arthrocentesis alone in treatment of patients with TMJ disc displacement with reduction.

Materials and methods

Forty patients for a total of forty joints with reducible anterior disc displacement, as confirmed by Magnetic Resonance Imaging (MRI) were selected and divided into 2 equal groups. In group I (control group), arthrocentesis alone was performed with Ringer solution. In group II (study group), a combination of arthrocentesis and intra-articular injection with 1.5 ml i-PRF was performed. The outcome variables included pain intensity evaluated with a visual analogue scale, inter-incisal opening, lateral movement evaluated in millimeters, and clicking. Assessments were done pre-operatively, and 1 week, 3 months, and 6 months postoperatively.

Results

There was statistically significant reduction in pain intensity and clicking sound and increase in mouth opening and lateral movement in i-PRF group when compared to arthrocentesis group. In addition, the differences between preoperative and postoperative status in all the measured parameters were statistically significant within the study and the control group throughout the postoperative period.

Conclusion

The combination of i-PRF with arthrocentesis is a safe and effective method in the treatment of TMJ disc displacement with reduction.

Paravertebral intramuscular ozone therapy in lumbar disc hernia: A comprehensive retrospective study

BACKGROUND

Clinical studies assessing the impacts of ozone on the musculoskeletal framework are slowly expanding.

OBJECTIVE

In this study, we analyzed the impact of paravertebral ozone treatment (OT) injection treatment on distress and disability in patients with lumbar disc hernia (LDH).

METHODS

The records of 432 patients with L4-5 and L5-S1 LDH were examined retrospectively. 298 patients who met the inclusion criteria and who provided written informed consent were divided into two groups. Each group received 15 sets of physiotherapy at a rate of five sets every week (study group (n= 139), control group (n= 159)). Six OT injections were applied solely to the study group, two days per week. A visual pain score (VAS) was set up for distress and the Oswestry Disability Questionnaire (ODI) for disablement was administered when the groups were called to control before treatment, towards the end of the treatment, and three months after the treatment ended.

RESULTS

The groups had significantly reduced (p< 0.05) VAS and ODI scores following and three months after the treatment contrasted with their scores before the treatment. The Physiotherapy + OT group had significantly lower (p< 0.05) VAS and ODI scores than the physiotherapy group following and three months after the treatment.

CONCLUSIONS

Paravertebral OT injection is quite a safe and helpful treatment technique in LDH patients. Further studies should be conducted to investigate the long-term outcomes of the paravertebral OT application.

Therapeutic Agents for the Treatment of Temporomandibular Joint Disorders: Progress and Perspective

Temporomandibular joint disorders (TMD) are a common health condition caused by the structural or functional disorders of masticatory muscles and the temporomandibular joint (TMJ). Abnormal mandibular movement in TMD patients may cause pain, chronic inflammation, and other discomfort, which could be relieved by a variety of drugs through various delivery systems. In this study, we summarized commonly used therapeutic agents in the management of TMD as well as novel bioactive molecules in preclinical stage and clinical trials. The emerging therapy strategies such as novel intra-TMJ delivery systems and implants based on tissue engineering are also discussed. This comprehensive review will strengthen our understanding of pharmacological approaches for TMD therapy.

Effectiveness of Ozone Injection Therapy in Temporomandibular Disorders

Temporomandibular disorder is a multifactorial disease that causes pain in the jaw and face area with nondental origin, which frequently limits talking, chewing, and other jaw activities. Various factors such as malocclusion, trauma, stress, parafunctional habits (clenching and bruxing), osteoarthritis, and synovitis play a role in its occurrence, although the etiology of these disorders is little understood. Several treatments are being used to treat these disorders. Ozone therapy has been recently introduced as one of these treatments. Considering that no extensive study has been found in this field so far, this study is aiming to report the studies that have been conducted to determine the efficacy of ozone injection therapy in temporomandibular joint disorders. This report addresses the studies which are conducted clinically, experimentally, and semi-experimentally over the past 10 years (2009-2019). The prepared articles are screened according to the inclusion criteria. In this study, total six related articles are addressed. One study was pre- and postintervention, and five studies were clinical trials. Studies show that although more studies are needed in contrast with occlusal splint, ozone therapy is generally more effective treatment for pain reduction compared to medication.

Clinical utility of ozone therapy in dental and oral medicine

Ozone is a highly reactive compound composed of three oxygen atoms that acts as an oxidant and oxidizer. It exists at the ground level as an air pollutant and a constituent of urban smog, as well as in the Earth’s upper atmosphere as a protective layer from ultraviolet rays. Healthy cells contain antioxidants such as vitamins C and E to protect against ozone oxidization. However, pathogens such as bacteria contain very trace amounts of antioxidants in their membranes, which make them susceptible to ozone and destroy the cell membrane. This review explores the history, composition, and use of ozone worldwide in dentistry. Ozone therapy has thus far been utilized with wound healing, dental caries, oral lichen planus, gingivitis and periodontitis, halitosis, osteonecrosis of the jaw, post-surgical pain, plaque and biofilms, root canals, dentin hypersensitivity, temporomandibular joint disorders, and teeth whitening. The utility of ozone will undoubtedly grow if studies continue to show positive outcomes in an increasing number of dental conditions.

Ozone therapy a new vista in dentistry: integrated review

Application of ozone in oral care comes as new and alternative treatment modality in dentistry. The impact of biological and digital information leads to use of ozone application by various means for numerous treatment options in oral cavity. Ozone is a form of oxygen, which has an effective role in management of oral diseases. This review mainly emphasizes on utility of ozone in oral health care management. Its therapeutic potential and its clinical application in oral pathologies, periodontology, endodontics, oral surgery, prosthodontics, orthodontics, restorative dentistry, wound healing, tooth mineralization as treatment choice are reviewed.

Effectiveness of acupuncture, ozonio therapy and low-intensity laser in the treatment of temporomandibular dysfunction of muscle origin: a randomized controlled trial

Abstract Introduction One of the most common causes of orofacial pain is temporomandibular disorder (TMD). Objective The aim of this study was to compare the effectiveness of acupuncture, ozone therapy and laser therapy in the treatment of muscle TMD patients through a randomized controlled trial. Material and method Twelve professors and postgraduate students from the University of Passo Fundo, diagnosed with TMD, aged between 23 and 50 years old, of both sexes, were evaluated. Individuals were randomly divided into 3 groups: G1: laser therapy, G2: acupuncture, and G3: ozone therapy. TMD diagnostic questionnaires (RDC / TMD), Quality of Life Questionnaire (OHIP-14), Pain Scale (VAS) and maximum mouth opening were applied. Descriptive statistics and percentage were used for sample characterization, which were presented using absolute and relative frequency distributions. Qualitative variables were analyzed with Wilcoxon tests p≤0.05. Result There was no statistically significant difference between treatments. Regarding pain and maximum mouth opening, the groups showed no statistical difference when individually analyzed, but when compared in general, they did (p=0.002 and p=0.003). Conclusion It can be considered that all treatments were able to decrease pain and improve maximal opening capacity related to muscle TMD. It can also be concluded that the TMD-related quality of life, in relation to the pain variable, was generally effective when compared before and after the interventions.

Clinical utility of ozone therapy for musculoskeletal disorders

Oxygen-ozone (O₃) therapy serves as an alternative medical technique that increases the oxygen in the body along with the introduction of O₃. O₃ therapy has finally reached a level where the biological mechanisms of action have been understood, showing that they are in the domain of physiology, biochemistry, and pharmacology. Few clinical applications have been reviewed here as well as exemplifying that O₃ therapy is particularly useful in musculoskeletal disorders. In the therapeutic range, O₃ can be used as a more effective and safe substitute of standard medications. O₃ therapy has been used for many years for its ability to inactivate various viruses, cancer, and acquired immune deficiency syndrome but is now making strides in the treatment of musculoskeletal disorders such as rheumatoid arthritis, lumbar facet joint syndrome, subacromial bursitis, carpal tunnel syndrome, osteoarthritis, hip bursitis, shoulder adhesive capsulitis, herniated disc, and temporomandibular joint disorder.

Ozone therapy ameliorates inflammation and endometrial injury in rats with pelvic inflammatory disease

As a common cause of infertility, pelvic inflammatory disease (PID) is characterized by chronic pain, ectopic pregnancy as well as inflammation and infection of the female upper genital tract. Ozone water, also known as O_3, has been previously reported to be a distinctly effective agent in treating inflammation. During the present study, we asserted the hypothesis that O₃ could be applied by pelvic inflammation and works to regulate the expression of inflammatory factors including interleukin-6 (IL-6), IL-2 and tumor necrosis factor-α (TNF-α). In an attempt to evaluate the effect of O₃ on PID, an acute PID rat model was subsequently established. O₃ at concentrations of 45 μg/mL and 60 μg/mL in addition to levofloxacin (LVLX) was injected respectively into the PID rats in a bid to alter the contents of inflammatory factors and immunologic markers. Hematoxylin-eosin (HE) staining was applied to analyze endometrial inflammation. Reductions to the contents of IL-6 and TNF-α were recorded, while that of IL-2, IgA, IgG, IgM, C3 and C4, and E rosette formation rate and transformation rate of T lymphocytes exhibited notably elevated levels after the PID rats had been injected with 45 μg/mL O₃, 60 μg/mL O₃ or LVLX. The pathological condition of the endometrium in rats with PID was alleviated among the PID rats after injected with the 45 μg/mL O₃, 60 μg/mL O₃ or LVLX. Taken together, the key findings of the current study present evidence demonstrating that the administration of O₃ to the pelvic cavity ameliorated the PID conditions among rat models via inhibition of the necrosis of the endometrial epithelial cells as well as alleviated the inflammatory reactions, highlighting a potential novel PID treatment target.

Effects of medical ozone upon healthy equine joints: Clinical and laboratorial aspects

OBJECTIVE

The aim of this study was to verify whether transient inflammatory reactions induced by intra-articular medicinal ozone administration affect joint components, by in vivo evaluation of inflammatory (prostaglandin E2, Substance P, Interleukin-6, Interleukine-1, Tumor Necrosis Factor), anti-inflammatory (Interleukin-10) and oxidative (superoxide dismutase activity and oxidative burst) biomarkers and extracellular matrix degradation products (chondroitin sulphate and hyaluronic acid) in synovial fluid.

METHODS

The effects of medicinal ozone were analyzed at two ozone concentrations (groups A and B, 20 and 40 μg/ml, respectively), using oxygen-injected joints as controls (group C); each group received ten treatments (15 ml gas per treatment). Physical evaluation, evaluation of lameness, ultrasonography, and synovial fluid analysis were performed.

RESULTS

All joints presented mild and transient effusion throughout the study. Group B exhibited the highest lameness score on day 14 (P<0.05), detected by the lameness measurement system, probably because of the higher ozone concentration. All groups exhibited increased ultrasonography scores on day 14 (P < 0.05). Groups A and B exhibited increased proteins concentrations on day 21 (P<0.05). There was no change in hyaluronic acid concentration or the percentage of high-molecular weight hyaluronic acid throughout the experiment. Chondroitin sulfate concentrations decreased in group B, and did not change in group A and C, indicating that neither treatment provoked extracellular matrix catabolism. Cytokine and eicosanoid concentrations were not significantly changed.

CONCLUSIONS

The ozonetherapy did not cause significant inflammation process or cartilage degradation, therefore, ozonetherapy is safe at both evaluated doses.

Management of pain in TMD patients: Bio-oxidative ozone therapy versus occlusal splints

OBJECTIVE

To compare the effects of bio-oxidative ozone application with occlusal splints in temporomandibular disorder (TMD) patients with pain.

METHODS

Forty participants were selected after the diagnosis of TMD and randomly divided into two groups: ozone group (OG, n = 20) and occlusal splint group (OCSG, n = 20). Ozone was applied to patients three times per week, for a total of six sessions. Patients in the OCSG were instructed to use occlusal splints every night over a period of four weeks.

RESULTS

Mandibular movements showed significant differences for the time factor in OG and OCSG. Pressure pain thresholds of the temporal and masseter muscles at follow-up were significantly higher in the OCSG group. Both treatments statistically decreased the visual analog scale (VAS) scores. However, no statistically significant difference was observed between groups after the application of treatments.

DISCUSSION

Occlusal splint treatment is still the gold treatment modality for objective pain relief in patients with TMD pain.

Effect of high-frequency bio-oxidative ozone therapy for masticatory muscle pain: a double-blind randomised clinical trial

To evaluate the effect of bio-oxidative ozone application at the points of greatest pain in patients with chronic masticatory muscle pain. A total number of 40 (40 women, with a mean age of 31·7) were selected after the diagnosis of myofacial pain dysfunction syndrome according to the Research Diagnostic Criteria for temporomandibular disorder (RDC/TMD). The patients were randomly divided into two groups: patients received the ozone therapy at the point of greatest pain, ozone group (OG; n = 20); patients received the sham ozone therapy at the point of greatest pain, placebo group (PG; n = 20). Ozone and placebo were applied three times per week, for a total of six sessions. Mandibular movements were examined, masticator muscles tenderness were assessed and pressure pain threshold (PPT) values were obtained. Subjective pain levels were evaluated using visual analogue sale (VAS). These assessments were performed at baseline, 1 month and 3 months. Ozono therapy decreased pain intensity and increased PPT values significantly from baseline to 1 month and 3 months in OG compared with PG. PPTs of the temporal (OG = 24·85 ± 6·65, PG = 20·65 ± 5·43, P = 0.035) and masseter (OG = 19·03 ± 6·42, PG = 14·23 ± 2·95, P = 0.007) muscles at 3 months of control (T2) were significantly higher in the OG group. PPT value of the lateral pole was also significantly higher at T2 in the OG group (OG = 21·25 ± 8·43, PG = 15·35 ± 4·18, P = 0.012). Mandibular movements did not show significant differences between treatment groups except right lateral excursion values at T2 (OG = 8·90 ± 1·77, PG = 6·85 ± 2·41, P = 0.003); however, OG demonstrated significantly better results over time. Overall improvements in VAS scores from baseline to 3 months were OG 67·7%; PG 48·4%. Although ozone therapy can be accepted as an alternative treatment modality in the management of masticatory muscle pain, sham ozone therapy (placebo) showed significant improvements in the tested parameters.

Intraprostatic ozone therapy: A minimally invasive approach in benign prostatic hyperplasia

Introduction:

Transurethral resection of prostate (TURP) remains the golden standard therapy since decades. There are various minimally invasive therapies (MITs) for the treatment of benign prostatic hyperplasia (BPH). Still, there is a need for therapy with lesser side effects and better outcome. We had studied the effect of intraprostatic ozone injection (IPOI) as an MIT for patients with BPH who have failed trial without catheter (TWOC).

Materials and Methods:

Thirty elderly patients with BPH with a prostate size of 30 g or more were enrolled for the study. Forty milliliters of ozone at a concentration of 30 μg/dl was injected in prostate (20 ml in each lateral lobe) per rectally. Prostate volume (PV) by ultrasonography was assessed after catheter removal on the 7^th day and after 1 month.

Observations and Results:

Totally thirty patients (mean age - 67.8 years) with mean prostatic volume (MPV) of 46.10cc received IPOI. MPV came as 44.96cc on the 7^th day of postozone therapy (P = 0.008). Successful voiders showed a significant reduction in PV (mean = 13.12cc) as compared to unsuccessful voiders (mean = 2.61cc) after 1 month.

Conclusion:

Intraprostatic ozone injection helps to reduce the PV to some extent and can be helpful in patients who have failed TWOC even on alpha blockers and are unfit for TURP. Larger studies are required to assess the efficacy and long-term results of this technique.

Internal derangement in the temporomandibular joint of juveniles with clinical signs of TMD : MRI-assessed association with skeletal and dental classes

AIM

The aim of this study was to investigate possible correlation of specific skeletal or dental class in children and adolescents with clinical signs of temporomandibular dysfunction (TMD) with the severity of internal derangement (ID) of the temporomandibular joint.

MATERIALS AND METHODS

Based on MRI images, the ID of 232 juvenile temporomandibular joints in 116 patients were retrospectively recorded. The distribution of the ID stages within the skeletal and dental classes was compared by means of the χ ² test.

RESULTS

Excluding the comparison between skeletal Class I (S I) and skeletal Class II (S II; p < 0.05), no statistically significant differences in the distribution of the ID stages were found between the skeletal classes (p > 0.05). No statistically significant differences were found when comparing the distribution of the ID stages between the dental classes (p > 0.05).

CONCLUSION

According to these findings, there is no skeletal or dental class that is related to higher degrees of internal derangement in the TMJs of children and adolescents presenting clinical signs of TMD. Therefore, it is not possible to draw conclusions about the severity of the ID in relation to the dental and skeletal class in symptomatic juvenile TMJs.

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.

Medical ozone therapy as a potential treatment modality for regeneration of damaged articular cartilage in osteoarthritis

Osteoarthritis (OA) is the most common degenerative joint disease and a growing health problem affecting more than half of the population over the age of 65. It is characterized by inflammation in the cartilage and synovium, resulting in the loss of joint structure and progressive damage to the cartilage. Many pro-inflammatory mediators are elevated in OA, including reactive oxygen species (ROS) such as nitric oxide (NO) and hydrogen peroxide (H₂O₂). Damaged articular cartilage remains a challenge to treat due to the limited self-healing capacity of the tissue and unsuccessful biological interventions. This highlights the need for better therapeutic strategies to heal damaged articular cartilage. Ozone (O₃) therapy has been shown to have positive results in the treatment of OA; however the use of O₃ therapy as a therapeutic agent is controversial. There is a perception that O₃ is always toxic, whereas evidence indicates that when it is applied following a specified method, O₃ can be effective in the treatment of degenerative diseases. The mechanism of action of O₃ therapy in OA is not fully understood and this review summarizes the use of O₃ therapy in the treatment of damaged articular cartilage in OA.

Effects of high-frequency bio-oxidative ozone therapy in temporomandibular disorder-related pain

OBJECTIVE

It was the aim of this study to compare the efficacy of ozone therapy and drug treatment in patients with painful temporomandibular joint (TMJ) disorder (TMD).

SUBJECTS AND METHODS

A total of 63 patients with TMD were enrolled; 33 were treated with bio-oxidative therapy and 30 with a ketoprofen tablet thiocolchicoside capsule 2 × 1 for 7 days. Maximum voluntary interincisal mouth opening (MMO) was measured in millimeters using a scale and recorded during the pre- and posttreatment periods. The patients evaluated their subjective pain using a visual analogue scale (VAS). Data were analyzed using the Mann-Whitney U test, the Kolmogorov-Smirnov test, and the independent t test.

RESULTS

The mean MMO of the group that received ozone therapy during the pretreatment period was 46.51 ± 8.2 mm, and it immediately increased to 48.78 ± 7.5 mm after 1 week of ozone therapy, which was statistically significant (p = 0.04). For those who received medication, the mean MMO during the pretreatment period was 46.30 mm, and at the end of 1 week it was 46.9 mm. In the ozone group, 29% of patients showed a gradual decrease in their VAS pain scores compared to pretreatment values (6.3 ± 2.1 to 3.0 ± 2.2). In the medication group, 24% of patients showed a significant decrease in VAS pain scores during the follow-up period (6.9 ± 1.4 to 5.0 ± 1.5).

CONCLUSION

This study showed that bio-oxidative therapy was a more effective treatment than medication therapy for relieving TMJ pain.

Interventional musculoskeletal US: an update on materials and methods

Pain is one of the most common causes of reduced productivity. The annual cost of health-related reductions in productivity has been estimated at approximately 225 billion dollars in the United States alone. Ultrasound-guided locoregional infiltration procedures have frequently been shown to offer economical, effective, lasting relief of pain. In-depth familiarity with the equipment (probes and needles) and techniques used to perform these procedures are fundamental for safe, effective treatment. In fact, depending on the characteristics of the patient and the clinical problem, the approach and technique may have to be modified to simplify the procedure and ensure better results. Up-to-date knowledge of the drugs used for these infiltrations (indications, how they are used) is equally important. Our aim is to provide an update on the techniques and materials used in interventional musculoskeletal ultrasonography based on a review of the most recent literature as well as on our personal experience.

Ozone treatment of alveolar bone in the cape chacma baboon does not enhance healing following trauma

In the international literature, the role of Ozone (O3) in the advancement in alveolar bone healing in the absence of bone pathology was not tested before. The purpose of this study was to evaluate alveolar bone regeneration after a bone defect was created and treated with a single topical administration of O3. Alveolar bone defects were created on five healthy chacma baboons. One side of the maxilla and mandible was topically treated with a single treatment of an O3/O2 mixture (3,5-4 % O3), while the opposite sides were not treated and thus served as control. Regeneration was measured radiologically, using a standardized gray scale, as the increase in bone density in the treatment area at 3 and 6 weeks post-operative and was statistically analyzed using multivariate analysis of variance (MANOVA). There were no significant differences in densities observed between the O3/O2 mixture treatment and the control (p > 0.05). A single O3 treatment did not increase alveolar bone healing over a 3- and 6-week period in the mandible and the maxilla.