Microbicidal efficacy of ozonated water against Candida albicans adhering to acrylic denture plates

Comparative Evaluation of Antifungal Efficacy of 3% Sodium Hypochlorite, 2% Chlorhexidine Gluconate, Ozonated Water, Alum Water, and Normal Saline Solutions against Endodontopathogenic Microorganism, Candida Albicans: A Microbiological In Vitro Study

Aims and objective

To compare and evaluate the antifungal efficacy of 3% sodium hypochlorite (NaOCl), 2% chlorhexidine (CHX) gluconate, 4 mg/mL ozonated water, and 2M alum water against Candida albicans (C. albicans).

Materials and methods

A total of 35 patients were selected from those attending the outpatient department of Pedodontics and Preventive Dentistry at Santosh Dental College and Hospitals, Ghaziabad. Their salivary samples were taken and cultured on a Sabouraud's dextrose agar (SDA) plate. The antifungal efficacy of 3% NaOCl, 2% CHX gluconate, 4 mg/mL concentration of ozonated water, and 2M alum water was assessed against clinical strains of C. albicans with the help of agar well diffusion method. The microbial isolates were inoculated into 10 mL of sterile peptone water and incubated at 37°C for 8 hours. The cultures were swabbed on the surface of sterile Mueller-Hinton agar plates using a sterile cotton swab. Five wells of 6 mm diameter were punched in each Petri dish. Around 100 µL of each test solution was poured into the designated wells. Further, the plates were incubated in an upright position at 37°C for 24 hours. The antifungal activity of the test solutions was determined by measuring the diameter of the inhibition zone in mm produced against the Candida isolates, and means were calculated.

Results

It was observed that all test solutions used in this study were inhibitory against C. albicans but with a variation in the size of inhibitory zones. According to the means of the diameter of inhibitory zones for all test solutions, the 3% NaOCl represented the statistically significant largest average zones of inhibition against C. albicans, followed by 2% CHX when compared with the other two test solutions alum water and ozonated water. Ozonated water produced the smallest mean inhibitory zone.

How to cite this article

Sharma A, Naorem N, Srivastava B, et al. Comparative Evaluation of Antifungal Efficacy of 3% Sodium Hypochlorite, 2% Chlorhexidine Gluconate, Ozonated Water, Alum Water, and Normal Saline Solutions against Endodontopathogenic Microorganism, Candida Albicans: A Microbiological In Vitro Study. Int J Clin Pediatr Dent 2024;17(S-1):S17-S24.

Assessing the efficacy of gutiferone E in photodynamic therapy for oral candidiasis

The rise in antifungal resistance and side effects of conventional treatments drive the search for innovative therapies like Photodynamic Therapy (PDT). This study explored the efficacy of PDT mediated by gutiferone, an isolated compound from red propolis, for candidiasis treatment. Multiple evaluation methods were employed, including determining the minimum inhibitory concentration (MIC) via broth microdilution, quantifying biomass using crystal violet detachment, and cell counting through total plate count. PDT mediated by gutiferone was also assessed in five groups of mice, followed by histopathological examination and agar plating of lingual tissue samples. Among the seven Candida species tested, gutiferone displayed efficacy against C. albicans, C. glabrata, and C. tropicalis, with MIC values of 1000 μg/mL. In C. tropicalis biofilms, exposure to gutiferone led to a reduction of 1.61 Log10 CFU/mL. PDT mediated by gutiferone achieved an average reduction of 3.68 Log10 CFU/mL in C. tropicalis biofilm cells, underscoring its potent fungicidal activity. Histopathological analysis revealed fungal structures, such as pseudohyphae and hyphae, in infected groups (G2) and irradiated mice. In contrast, groups treated with gutiferone or subjected to gutiferone-assisted PDT (G5) exhibited only few blastoconidia. Furthermore, CFU/mL assessments in lingual tissue post-treatment demonstrated a significantly lower count (0.30 Log10 CFU/mL) in the G5 group compared to G2 (2.43 Log10 CFU/mL). These findings highlight the potential of PDT mediated by gutiferone as a promising alternative for managing denture stomatitis. Future research and clinical investigations offer the promise of validating its clinical applicability and improving outcomes in the treatment of oral candidiasis.

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.

The Immune System Response to Porphyromonas gingivalis in Neurological Diseases

Previous studies have reported an association between oral microbial dysbiosis and the development and progression of pathologies in the central nervous system. Porphyromonas gingivalis (Pg), the keystone pathogen of the oral cavity, can induce a systemic antibody response measured in patients' sera using enzyme-linked immunosorbent assays. The present case-control study quantified the immune system's response to Pg abundance in the oral cavities of patients affected by different central nervous system pathologies. The study cohort included 87 participants: 23 healthy controls (HC), 17 patients with an acute neurological condition (N-AC), 19 patients with a chronic neurological condition (N-CH), and 28 patients with neurodegenerative disease (N-DEG). The results showed that the Pg abundance in the oral cavity was higher in the N-DEG patients than in the HC (p = 0.0001) and N-AC patients (p = 0.01). In addition, the Pg abundance was higher in the N-CH patients than the HCs (p = 0.005). Only the N-CH patients had more serum anti-Pg antibodies than the HC (p = 0.012). The inadequate response of the immune system of the N-DEG group in producing anti-Pg antibodies was also clearly indicated by an analysis of the ratio between the anti-Pg antibodies quantity and the Pg abundance. Indeed, this ratio was significantly lower between the N-DEG group than all other groups (p = 0.0001, p = 0.002, and p = 0.03 for HC, N-AC, and N-CH, respectively). The immune system's response to Pg abundance in the oral cavity showed a stepwise model: the response diminished progressively from the patients affected with an acute condition to the patients suffering from chronic nervous system disorders and finally to the patients affected by neurodegenerative diseases.

Novel intrathoracic irrigation using ultrafine ozone bubbles in a rat empyema model

Dissolved ozone is generally used for sanitization, but it has not been used for thoracic cavity sanitization because of its short half-life (< 20 min) and possible toxicity. We developed a novel solution containing ultrafine ozone bubbles (ozone-UFB) with a fivefold longer half-life than non-UFB ozone. Using an in vitro model, Staphylococcus aureus colonies were counted after exposure to ozone-UFB or non-UFB ozone at the same ozone concentration (0.4 mg/L). The colony count was significantly lower in the ozone-UFB group than in the non-UFB ozone group (p = 0.034). The effect of repeated pleural irrigation using ozone-UFB and saline was compared in a rat empyema model of S. aureus infection. The bacterial count in the pleural effusion was decreased by at least fivefold following intrathoracic lavage with ozone-UFB (3 mg/L). To examine the safety of ozone-UFB for intrathoracic use, ozone-UFB with a higher ozone concentration (10 mg/L) was injected into the thoracic cavities of normal rats. The treatment did not result in any specific pleural damage or elevated serum interleukin-6 concentrations. The findings highlighted the efficacy and safety of ozone-UFB for intrathoracic sanitization, but further studies are needed to determine the optimal therapeutic ozone concentration with appropriate safety margins.

Comparison between ozone and CHX gel application for reduction of pain and incidence of dry socket after lower third molar removal

OBJECTIVES

The aim of this study is to evaluate the efficacy between ozone gas and 1% chlorhexidine (CHX) gel in the incidence of dry socket after surgical extraction of impacted lower third molars.

MATERIAL AND METHODS

Overall, 30 patients of both genders were included in the study, with indication of surgical extraction of lower third molar, positioned similarly after being clinically and radiographically checked by X-ray and orthopantomography. Each patient was subjected to both groups in separate sessions: treated with ozone gas and with CHX gel 1%. Data on pain intensity, number of taken analgesics-painkillers, and dry socket were recorded for 48 h and at Day 7.

RESULTS

Ozone gas and CHX gel effectively reduced pain intensity and prevented dry socket. The number of taken analgesics 48 h and 7 days after surgery showed no statistical significance. The same was observed for the distribution of pain. Only one patient reported the occurrence of dry socket 7 days after the surgical extraction.

CONCLUSIONS

Ozone gas and CHX 1% gel are both efficient in decreasing postoperative symptoms and incidence rates of dry socket, but in comparison to each other, the use of ozone gas is showing a bit better prevention capability.

Fracture strength of Er,Yag laser treated PMMA denture-based polymer (DBP) colonized with C. albicans, S. aureus, S.mutans, and E.coli

AIM

To assess and equate the efficacy of different disinfection protocols autoclave, chlorhexidine (CHX), PDT utilizing Rose Bengal (RB), chitosan, and Er, Yag laser and their effect on fracture strength of PMMA denture-based polymer (DBP) colonized with C. Albicans, S. aureus, S.mutans, and E.coli.

MATERIAL AND METHODS

A total of 50 (n = 10) PMMA DBP were manufactured and adulterated with the American Type Culture Collection (ATCC) of diverse microbial colonies inhabited by C. Albicans, S. aureus, S.mutans, and E.coli. The specimens were subjected to different denture disinfection approaches by randomly distributing in into five groups i.e., Er, Yag laser, RB, autoclave, CHX, and Chitosan, respectively for appraising antimicrobial effectiveness. PMMA fracture load was also assessed and statistical analysis was performed for CFU/mL (log10) of exposed C. Albicans, S. aureus, S.mutans, and E.coli by one-way ANOVA and Tukey's multiple comparison test at a significance level of p < 0.05.

RESULTS

Intergroup comparison disclosed that denture disinfection with Er, Yag laser, autoclave, Chitosan, and CHX (control) validated comparable antimicrobial efficacy to denture against all inspected CFU/mL (log10) (p>0.05). The intragroup comparison revealed that DBP sanitization with Er, Yag laser, autoclave, Chitosan, RB, and CHX substantiated equivalent effective antimicrobial efficacy in plummeting CFU/mL (log10) of S. mutans and E. coli (p>0.05) but in consideration to S.aureus and C.albicans, all groups resulted in declining their count except 5µm RB activated by PDT(p < 0.05). No significant difference was perceived in fracture load of PMMA denture base among Er, Yag laser, RB, chitosan, and CHX (control) (p > 0.05) except autoclave decontamination procedure that indicated the least fracture strength of DBP when disinfected (p < 0.05).

CONCLUSION

Er, Yag laser, and Chitosan activated by PDT have the potential to be used as an alternative to chlorhexidine for disinfecting Polymethyl methacrylate denture base as they demonstrated the highest antimicrobial efficacy against E. coli, C. Albicans, S aureus, and S. mutans with optimal fracture load.

Ozonated oil is effective at killing Candida species and Streptococcus mutans biofilm-derived cells under aerobic and microaerobic conditions

This study explores the growth of bacterial, fungal, and interkingdom biofilms under aerobiosis or microaerobic conditions and the effect of ozonated sunflower oil on these biofilms. Candida species and Streptococcus mutans were used to study this interaction due to their importance in oral health and disease as these microorganisms display a synergistic relationship that manifests in the onset of caries and tooth decay. Biofilms were developed in a 96-well microtiter plate at 37ºC for 24 h, under aerobiosis or microaerobic conditions, and treated with ozonated oil for 5 to 120 min. All the microorganisms formed biofilms in both oxygenation conditions. Scanning electron microscopy was used to visualize biofilm morphology. Rodent experiments were performed to verify the oil-related toxicity and its efficacy in oral candidiasis. The growth of all Candida species was increased when co-cultured with S. mutans, whilst the growth of bacterium was greater only when co-cultured with C. krusei and C. orthopsilosis under aerobiosis and microaerobic conditions, respectively. Regardless of the oxygenation condition, ozonated oil significantly reduced the viability of all the tested biofilms and infected mice, showing remarkable microbicidal activity as corroborated with confocal microscopy and minimal toxicity. Thus, ozonated oil therapy can be explored as a strategy to control diseases associated with these biofilms especially in the oral cavity.

LAY SUMMARY

We demonstrated that ozonated sunflower oil is effective at killing the biofilms formed by Candida species, by the bacterium Streptococcus mutans, or by both micoorganisms that can interact in the oral cavity, making it a potential therapeutic option for the treatment of these infections.

Antifungal Efficacy of Sodium Perborate and Microwave Irradiation for Surface Disinfection of Polymethyl Methacrylate Polymer

Various disinfecting agents showing variable success in disinfecting polymethyl methacrylate (PMMA) are available. The aim of our study was to evaluate the antifungal efficacy of sodium perborate (denture cleaning tablet-DC), microwave irradiation, and their combination for eradicating candida albicans (C. albicans) from polymethyl methacrylate (PMMA) denture base polymer. One hundred and sixty-eight PMMA resin specimens (30 × 30 × 15 mm) were divided into four groups, including control (no disinfection), microwave disinfection in distilled water (MW-DW), sodium perborate with distilled water (DC-DW), and a combination of MW-DC-DW (n = 10). Biofilms of C. albicans were cultured on the PMMA resin denture base specimens for 96 h. The samples were exposed to three different antifungal regimes, i.e., MW, denture cleaning agent-sodium perborate (DC) and DW, and a combination of MW-DC-DW for 1 to 5 min. Scanning electron microscopy (SEM) was performed to evaluate colony formation. The colony-forming units (CFU) among the experimental groups were assessed using ANOVA, a Kruskal–Wallis test, and a Mann–Whitney test. The mean CFU values were compared with the control for each disinfecting regime at 96 h growth time. For MW-DC-DW, the CFU were significantly low at 2 and 3 min of exposure when compared with the control (DW) (p < 0.05). For the MW-DW treated group, the CFU were significantly low at 3 min of exposure when compared with the control (DW) (p < 0.05). It was also found that for DC-DW, the CFU were significantly low at 5 minutes when compared with the control specimens (DW) (p < 0.05). Microwave disinfection in combination with sodium perborate is a more effective disinfecting regime against C. albicans than that of microwave disinfection and sodium perborate alone.

Bacterial Disinfection of Polymethyl Methacrylate (PMMA) Resin Polymer Using Low Level Microwave Irradiation and Denture Cleaning Agent

The aim was to evaluate the disinfection of E. coli, S. aureus and S. mutans cultured on Polymethyl Methacrylate (PMMA) resin polymer using microwave disinfection and sodium perborate (DC). Biofilms of E. coli, S. aureus and S. mutans were cultured on the PMMA denture base for 24, 36, 48 and 96 h. Specimens were subjected to three disinfection protocols, including microwave disinfection in distilled water (MW-DW), sodium perborate (denture cleaning tablet) with distilled water (DC-DW) and a combination of MW-DC-DW for 1 to 5 min. Colony-forming units among the study groups were analyzed using Kruskal–Wallis and Mann–Whitney tests. For E. coli and S. aureus cultured on PMMA, the MW-DC-DW group displayed complete disinfection at 2 min of exposure. However, for both bacteria, the MW-DW disinfection group showed zero CFU at 3 min. DC disinfection for E. coli and S. aureus displayed zero CFU at 5 min of exposure (p ≤ 0.05). For S. mutans, MW-DC-DW and MW-DW displayed zero CFU count at 1 min and 2 min, respectively. In DC-treated samples, CFU were significantly zero at 4 min when compared with the control at each growth time. A combination of MW irradiation with DC (sodium perborate) showed higher disinfection percentage of bacterial species on PMMA polymer denture bases compared to MW and DC alone. PMMA disinfection using DC displayed a lower antimicrobial disinfection percentage than the combined use of MW and DC as well as MW alone at 1 min or 2 min disinfection for E. coli, S. aureus and S. mutans.

Study on the role of nano antibacterial materials in orthodontics (a review)

Nanoparticles (NPs) are insoluble particles with a diameter of fewer than 100 nanometers. Two main methods have been utilized in orthodontic therapy to avoid microbial adherence or enamel demineralization. Certain NPs are included in orthodontic adhesives or acrylic resins (fluorohydroxyapatite, fluorapatite, hydroxyapatite, SiO2, TiO2, silver, nanofillers), and NPs (i.e., a thin layer of nitrogen-doped TiO2 on the bracket surfaces) are coated on the surfaces of orthodontic equipment. Although using NPs in orthodontics may open up modern facilities, prior research looked at antibacterial or physical characteristics for a limited period of time, ranging from one day to several weeks, and the limits of in vitro studies must be understood. The long-term effectiveness of nanotechnology-based orthodontic materials has not yet been conclusively confirmed and needs further study, as well as potential safety concerns (toxic effects) associated with NP size.

Antimicrobial Effect of Ozone Therapy in Deep Dentinal Carious Lesion: A Systematic Review

Aim

This systematic review aimed to answer the following focused question: Is ozone therapy more effective in reducing microbial count as compared to conventional methods in deep dentinal carious lesion?

Objective

The purpose of this systematic review was to perform a review on the effectiveness of ozone therapy in reduction of microbial count in deep dentinal carious lesion. Study eligibility criteria, participants, and interventions: The inclusion criteria comprised studies that compared effect on microbial count in deep dentinal carious lesion after treatments with ozone and other disinfectants in primary or permanent teeth in randomized clinical trials.

Materials and methods

This review was conducted according to Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRIMSA) guidelines. The searched databases included Medline (via PubMed), Cochrane, and Google scholar. Articles published until 29 February 2020 without year restriction but only in English language were included.

Results

The search resulted in 359 published studies. After removal of duplicate studies and full-text analysis, seven studies were selected. Overall, the results demonstrated the promising effects of ozone therapy in reduction of microbial count as compared to other disinfectant.

Conclusions

Within the limitations of this review, it can be asserted that the ozone therapy is effective in reduction of microbial count in deep dentinal carious lesion.

Clinical significance

Ozone therapy can be a useful tool to reduce the microorganisms in deep dentinal carious lesion.

How to cite this article

Badhe H, Kalaskar R, Balasubramanian S, et al. Antimicrobial Effect of Ozone Therapy in Deep Dentinal Carious Lesion: A Systematic Review. Int J Clin Pediatr Dent 2022;15(S-2):S252-S260.

Ozone ultrafine bubble water inhibits the early formation of Candida albicans biofilms

This study aimed to investigate the effect of ozone ultrafine bubble water (OUFBW) on the formation and growth of Candida albicans (C. albicans) biofilms and surface properties of denture base resins. OUFBWs were prepared under concentrations of 6 (OUFBW6), 9 (OUFBW9), and 11 ppm (OUFBW11). Phosphate buffered saline and ozone-free electrolyte aqueous solutions (OFEAS) were used as controls. Acrylic resin discs were made according to manufacturer instructions, and C. albicans was initially cultured on the discs for 1.5 h. A colony forming unit (CFU) assay was performed by soaking the discs in OUFBW for 5 min after forming a 24-h C. albicans biofilm. The discs after initial attachment for 1.5 h were immersed in OUFBW and then cultured for 0, 3, and 5 h. CFUs were subsequently evaluated at each time point. Moreover, a viability assay, scanning electron microscopy (SEM), Alamar Blue assay, and quantitative real-time polymerase chain reaction (qRT-PCR) test were performed. To investigate the long-term effects of OUFBW on acrylic resin surface properties, Vickers hardness (VH) and surface roughness (Ra) were measured. We found that OUFBW9 and OUFBW11 significantly degraded the formed 24-h biofilm. The time point CFU assay showed that C. albicans biofilm formation was significantly inhibited due to OUFBW11 exposure. Interestingly, fluorescence microscopy revealed that almost living cells were observed in all groups. In SEM images, the OUFBW group had lesser number of fungi and the amount of non-three-dimensional biofilm than the control group. In the Alamar Blue assay, OUFBW11 was found to suppress Candida metabolic function. The qRT-PCR test showed that OUFBW down-regulated ALS1 and ALS3 expression regarding cell-cell, cell-material adhesion, and biofilm formation. Additionally, VH and Ra were not significantly different between the two groups. Overall, our data suggest that OUFBW suppressed C. albicans growth and biofilm formation on polymethyl methacrylate without impairing surface properties.

The Biological Effects of Ozone Gas on Soft and Hard Dental Tissues and the Impact on Human Gingival Fibroblasts and Gingival Keratinocytes

Ozone is an allotropic form of oxygen, so in the medical field ozone therapy has special effects. Starting from the premise that bio-oxidative ozone therapy reduces the number of bacteria, in the present study two approaches were proposed: to evaluate the biological effects of ozone gas on the tooth enamel remineralization process and to demonstrate its impact on the morphology and confluence of human primary gingival cells, namely keratinocytes (PGK) and fibroblasts (HGF). The ozone produced by HealOzone was applied in vivo to 68 M1s (first permanent molars), both maxillary and mandibular, on the occlusal surfaces at pit and fissure. The molars included in the study recorded values between 13 and 24 according to the DIAGNOdent Pen 2190 scale, this being the main inclusion/exclusion criterion for the investigated molars. Because the gas can make contact with primary gingival cells during the ozonation process, both human gingival fibroblasts and keratinocytes were exposed to different doses of ozone (20 s, 40 s, 60 s), and its effects were observed with the Olympus IX73 inverted microscope. The contact of ozone with the human primary gingival cells demonstrates cell sensitivity to the action of ozone, this being higher in fibroblasts compared to keratinocytes, but it is not considered toxic because all the changes are reversible at 48 h after exposure.

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.

Efficacy of Toluidine Blue-Mediated Antimicrobial Photodynamic Therapy on Candida spp. A Systematic Review

The effectiveness of antimicrobial photodynamic therapy (aPDT) in the treatment of oral yeast infections was examined many times in recent years. The authors of this review tried to address the question: "Should TBO (toluidine blue ortho)-mediated aPDT be considered a possible alternative treatment for oral candidiasis?". PubMed/Medline and the Cochrane Central Register of Controlled Trials (CEN-TRAL) databases were searched from 1997 up to the 27th of October 2020 using a combination of the following keywords: (Candida OR Candidiasis oral OR Candidosis oral OR denture stomatitis) AND (toluidine blue OR photodynamic therapy OR aPDT OR photodynamic antimicrobial chemotherapy OR PACT OR photodynamic inactivation OR PDI). Animal studies or in vitro studies involving Candida albicans (C. albicans) and/or nonalbicans stain, randomized clinical trials (RCT) involving patients with oral candidiasis or denture stomatitis published solely in English language were included. Candida elimination method in animal, in vitro studies and RCT used was TBO-mediated aPDT. Exactly 393 studies were taken into consideration. Then, after analyzing titles and abstracts of said studies, 361 were excluded. Only 32 studies ended up being selected for in-depth screening, after which 21 of them were included in this study. All studies reported the antifungal effectiveness of aPDT with TBO against C. albicans and non-albicans Candida. In studies conducted with planktonic cells, only one study showed eradication of C. albicans. All others showed partial elimination and only one of them was not statistically significant. Experiments on yeast biofilms, in all cases, showed partial, statistically significant cell growth inhibition and weight reduction (a reduction in the number of cells-mainly hyphae) and the mass of extracellular polymeric substance (EPS). In vivo aPDT mediated by TBO exhibits antifungal effects against oral Candida spp.; however, its clinical effectiveness as a potent therapeutic strategy for oral yeast infections requires further investigation.

Application of Selected Nanomaterials and Ozone in Modern Clinical Dentistry

This review is an attempt to summarize current research on ozone, titanium dioxide (TiO₂), silver (Ag), copper oxide CuO and platinum (Pt) nanoparticles (NPs). These agents can be used in various fields of dentistry such as conservative dentistry, endodontic, prosthetic or dental surgery. Nanotechnology and ozone can facilitate the dentist’s work by providing antimicrobial properties to dental materials or ensuring a decontaminated work area. However, the high potential of these agents for use in medicine should be confirmed in further research due to possible side effects, especially in long duration of observation so that the best way to apply them can be obtained.

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.

Efficacy of ozonized water for the treatment of erosive oral lichen planus: a randomized controlled study

BACKGROUND

Management of erosive Oral Lichen Planus (eOLP) is challenging. Currently, topical corticosteroids are widely used as first-line therapy, but they might be associated with side-effects and incomplete clinical response. Among non-pharmacological strategies, ozone at low medical concentration has proven to induce a mild activation of protective anti-oxidant pathways, thus exerting therapeutic effects in many inflammatory diseases. The aim of this randomized controlled study was to investigate the effectiveness of ozonized water in association with conventional topical corticosteroids for the treatment of eOLP.

MATERIAL AND METHODS

Fifty-one patients were included in the study and randomized into 2 groups: study group (n=26) included patients receiving ozonized water treatment; control group (n=25) included patients receiving placebo treatment (i.e. double-distilled water). Treatment protocol consisted of 1-minute oral rinses, repeated for 4 times, twice a week for 4 weeks. All patients received conventional corticosteroid topical therapy (betamethasone soluble tablets, 2 rinses/day for 4 weeks). Assessment of size of lesions, sign and pain scores was performed before treatment, after 2 weeks of treatment (T1) and at the end of 4-week treatment (T2). Efficacy Index (EI) of treatment, candidiasis and relapse rates were also recorded.

RESULTS

All patients experienced significant improvement of sign and pain scores with a higher rate of improvement in ozone-treated group (T1 improvement rates: Thongprasom 92.2% vs 28%; VAS pain 76.9% vs 32%; p<0.05). Pain and size reduction were significantly higher in ozone-treated group both at T1 and T2 (p<0.05). Ozone-treated group showed a higher EI at every time point (T0-T2: 72.77% vs 37.66%, p<0.01). Candidiasis (32% vs 11.5%) and relapse (40% vs 34.6%) rates were higher in control group, however the differences were not statistically significant.

CONCLUSIONS

Within the limitations of this study, ozonized water seems to be effective as an adjunct therapy, in combination with topical corticosteroids, for the treatment of eOLP.

Efficacy of ozonated water mouthwash on early plaque formation and gingival inflammation: a randomized controlled crossover clinical trial

OBJECTIVES

To evaluate the effect of ozonated water in early plaque formation and gingival inflammation.

MATERIALS AND METHODS

This was a randomized, controlled, double-blind, crossover clinical trial with two experimental periods of 96 h each, with 10 washout days between them. The sample consisted of 42 dental students divided into Test Group, mouthwash of ozonated water, and Control Group, bidistilled water mouthwash. The participants were instructed not to perform oral hygiene and used the assigned mouthwash under supervision once a day. For the investigation of the initial subgingival biofilm formation, the Plaque Free Zone Index was used at 24, 48, 72, and 96 h. The volume of gingival crevicular fluid, a questionnaire for taste perception assessment, and analysis of the adverse effects were also carried out.

RESULTS

The percentage of conversion scores 0 and 1 to 2 of PFZ Index, the main outcome, for all dental surfaces showed no statistical difference between Test and Control groups, with 19.07 and 19.79, respectively. Also, there was not a significant difference in the score frequencies at each time point. Evaluation of GCF demonstrated that both groups had an increase in volume during experimental periods and that there was no statistically significant difference among groups. Test group had worse evaluation of taste perception and more adverse effects.

CONCLUSIONS

Ozonated water seems not to affect the formation of supra and subgingival biofilms, as well as gingival inflammation.

CLINICAL SIGNIFICANCE

Mouthwash with ozonated water once a day do not affect supra and subgingival biofilm formation.

Effect of Herbal Water, Ozonated Water, Water, and Chlorhexidine Mouthrinses on Oral Health Status of Children: A Randomized Controlled Trial

Aim

To evaluate the antibacterial effect of herbal water, ozonated water, and chlorhexidine mouthrinses on salivary Streptococcus mutans level and to assess their effectiveness of these mouthrinses on the oral health status of children.

Materials and methods

A parallel multiarm randomized controlled trial was conducted in 100 children aged 10–12 years. Debris index-simplified (DI-S), calculus index-simplified (CI-S), oral hygiene index-simplified (OHI-S) scores, and Streptococcus mutans counts were recorded at baseline (T₁). They were randomly divided into four equal groups (n = 25): HW, herbal water; OW, ozonated water; W, water; and CHX, chlorhexidine. Intervention period was 15 days and data collection was repeated after 15 days (T₂) and 30 days (T₃). Saliva samples were used to evaluate S. mutans count. Results were tabulated and analyzed statistically.

Results

OW had minimum DI-S score at T₂ and T₃ periods. HW had the minimum CI-S score at T₂ and T₃ periods. CHX had the minimum S. mutans count at T₂ and T₃ periods. OW showed maximum reduction in OHI-S score at T₂ period. HW showed maximum reduction in OHI-S score at T₃ period.

Conclusion

Herbal water and ozone water can be used as an alternative to chlorhexidine in maintaining the oral health status.

Clinical significance

Herbal water and ozonated water can be used in children instead of chemical mouthrinses to avoid any adverse effects.

How to cite this article

Mon J, Asokan S, Priya PRG, et al. Effect of Herbal Water, Ozonated Water, Water, and Chlorhexidine Mouthrinses on Oral Health Status of Children: A Randomized Controlled Trial. Int J Clin Pediatr Dent 2019;12(6):514–519.

Effectiveness and safety of low-concentrated ozonized water for the reduction of contamination in dental unit water lines

Contamination of dental unit waterlines (DUWL) with heterotrophic bacteria can cause problems in immune compromised patients (aged, tumor and organ transplantation-patients). We focused on the use of low-concentrated ozonized water (OZW) as the biofilm formation restraint system for DUWL. Here, we examined the effects of low-concentrated OZW on the growth of bacteria and related biofilm formation and harmfulness to dental unit components (DUCs) in vitro.

OBJECTIVES

To evaluate the bactericidal effects of OZW on biofilms in DUWL and DUC in vitro.

METHODS

Low-concentrated OZW (0.4 mg/L) was generated using an OZS-PTDX generator. Heterotrophic bacterial biofilms in old DUWL tubes and Candia albicans solution (control microbe) were treated with OZW for 1 h with gentle agitation before static culturing for 96 h in Reasoner's 2A liquid media. The control solutions were 0.1% cetylpyridinium chloride (CPC), chlorinated tap water (TW), and phosphate-buffered saline (PBS). Adenosine triphosphate (ATP) amounts of the microbes were measured and the biofilms of these microbes were observed using scanning electron microscopy (SEM). Moreover, surfaces of DUC soaked in OZW and TW were observed by SEM.

RESULTS

The OZW reduced ATP levels in microbes to 50% compared to TW and PBS treatment, although CPC reduced it below detection limits. SEM observation revealed deformation of microbes cultured with OZW, whereas no changes were seen on DUC surfaces.

CONCLUSIONS

Low-concentrated OZW is bactericidal against heterotrophic bacteria biofilms and it is not harmful to DUC, suggesting that it might be useful in preventing DUWL contamination.

Endodontic biofilms: contemporary and future treatment options

Apical periodontitis is a biofilm-mediated infection. The biofilm protects bacteria from host defenses and increase their resistance to intracanal disinfecting protocols. Understanding the virulence of these endodontic microbiota within biofilm is essential for the development of novel therapeutic procedures for intracanal disinfection. Both the disruption of biofilms and the killing of their bacteria are necessary to effectively treat apical periodontitis. Accordingly, a review of endodontic biofilm types, antimicrobial resistance mechanisms, and current and future therapeutic procedures for endodontic biofilm is provided.

Kinetics of antifungal activity of home-generated ozonated water on Candida albicans

Background and Purpose:

Candida-associated denture stomatitis is one of the most common forms of oral candidiasis among denture wearers. Regarding this, the aim of the present study was to evaluate the antifungal effects of home-generated ozonated water on the adhesion of the C. albicans attached to the surface of the denture base acrylic resins.

Materials and Methods:

For the purpose of the study, different concentrations of C. albicans were added to the tubes containing acrylic resin blocks, and then incubated for 2 h at 35°C. The samples were assigned into three groups, each of which contained 42 samples, including normal saline (NS) solution as the negative control, nystatin (N) solution as the positive control, and ozonated water as the test group. The samples were washed and placed in an ultrasonic bath. Subsequently, the saline solution was cultured on Sabouraud dextrose agar. The concentrations of Candida were evaluated during the contact times.

Results:

The test group (i.e., ozonated water) with 114 colony-forming units (CFU) showed a significant reduction of Candida colonies, compared to the NS group with 2,172 CFU. The 120- and 1-minute incubation with ozonated water showed the highest and lowest effects on the viability of Candida adhered to the acrylic resin, respectively.

Conclusion:

Based on the findings, home-generated ozonated water can be applied to remove the Candida attached to the surface of the denture plates.

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.

Effect of ozonated water on the surface roughness of dental stone casts

Infection control of dental stone cast is an important issue. Ozone is effective for disinfection against microorganisms and inactivation of viruses. However, there is little information regarding the use of ozone. We prepared 4 types of gypsum specimens and 3 types of disinfectants (4-5 ppm Ozonated water [OZW], 2% glutaraldehyde [GL], and 1% sodium hypochlorite [SH]). Gypsum specimens were immersed in each disinfectant for 5 and 10 min, and surface roughness was then examined using laser scanning microscopy. Surface microstructure was investigated using scanning electron microscopy. Immersion of gypsum specimens in SH, GL, and OZW increased the surface roughness to a maximum of 1.04, 0.37, and 0.30 μm, respectively, based on the difference between the average values of surface roughness before and after the disinfection procedure. The effects of OZW and GL were comparable. OZW is useful as a candidate for relatively safe disinfection of material for dental stone casts.

Evaluation of Combined Topical Ozone and Steroid Therapy in Management of Oral Lichen Planus

AIM:

The present study aims to assess the therapeutic effect of the combination of topical ozone and steroid therapy in comparison to topical ozone alone versus topical steroid as a control in the management of atrophic - erosive oral lichen planus (OLP).

METHODS:

Sixty-six patients are having atrophic-erosive OLP were included in the study. They were randomly divided into three equal groups to be treated with topical corticosteroids alone (steroid group) as control, topical ozone alone (ozone group) or combination of topical steroids and ozone (combined group). Assessment of pain and sign scores was done before and after each treatment modality.

RESULTS:

The results revealed that the greatest significant percentage of change and subsequent improvement in pain and sign scores were recorded in the combined group.

CONCLUSION:

Reported data in this study using the combination of ozone and steroid therapy could provide a new promising safe and effective adjunct therapy for management of OLP.

Prevention of Cross-contamination Risk by Disinfection of Irreversible Hydrocolloid Impression Materials with Ozonated Water

Background:

Disinfection of dental impression is mandatory for preventing the cross infection between dental staff and dental laboratory. Ozone as a disinfectant can be used in various ways in dentistry. The aim of this study was to evaluate the efficacy of ozonated water for disinfection of irreversible hydrocolloid impression materials and preventing cross-contamination.

Methods:

Thirty-two circular specimens (1 cm diameter and 2 mm thickness) of irreversible hydrocolloid impression material were made. Thirty specimens were contaminated with Pseudomonas aeruginosa (ATCC 27853), Staphylococcus aureus (ATCC 51299), and Candida albicans (PTCC 5027). Except control samples (n = 2), the other specimens were immersed in ozonated water for 5 and 10 min (5 sample each group). Trypsin was used for separating microorganisms. Diluted microbial solution was analyzed microbiologically for colony-forming units (CFUs). Two-way repeated measure ANOVA and Scheffe post hoc test were used for data analysis (α = 0.05).

Results:

The number of CFUs after disinfection with ozonated water was decreased significantly (11.84%, 61.55%, and 20.27% after 5 min and 11.03%, 14.50%, and 16.99% after 10 min for P. aeruginosa, S. aureus, and C. albicans, respectively) (P < 0.001). Increasing the time of disinfection resulted in significant reduction in a number of S. aureus only (P < 0.001) although they did not vanish microorganisms completely.

Conclusions:

Immersion of irreversible hydrocolloid impression material in ozonated water for 10 min will not lead to complete disinfection but decreases the microorganisms to a level that can prevent infection transmission.

The efficacy of gaseous ozone against different forms of Candida albicans

Background and Purpose:

Ozone is an inorganic molecule with effective antimicrobial properties. Clinical treatment of ozonated water was used for the elimination of Candida albicans, Enterococcus faecalis, endotoxins, and biofilms from root canals. In addition, its therapeutic effects for tinea pedis, ulcers, and leishmaniasis were investigated. The purpose of the present study was to evaluate the fungicidal effects of ozone on different forms of C. albicans. In addition, antifungal susceptibility profile of strains was assessed before and after exposure to ozone.

Materials and Methods:

Fifty strains of C. albicans were exposed to gaseous ozone at different times. Furthermore, biofilm formation and germ tube production were evaluated when yeast suspensions were exposed to ozone. In addition, antifungal susceptibility of ozone resistant colonies was investiagted as compared to controls.

Results:

Ozone was highly effective in killing C.albicans in yeast form and inhibition of germ tube formation during 210 and 180 s, respectively. Although with increasing exposure time biofilm production was considerably decreased, resistance to ozone was much higher among vaginal and nail isolates even after 60 min. All the strains were sensitive to fluconazole, caspofungin, and terbinafine pre- and post-ozone exposure. Resistance to amphotericin B was significantly enhanced after exposure to ozone.

Conclusion:

Although ozone was highly effective on the yeast form of C.albicans and it can inhibit the formation of germ tubes in C.albicans, the complete removal of biofilms did not happen even after 60 min. It seems that ozone therapy induces resistance to amphotericin B.

Unusual Root Canal Irrigation Solutions

Microorganisms and their by-products play a critical role in pulp and periradicular pathosis. Therefore, one of the main purposes of root canal treatment is disinfection of the entire system of the canal. This aim may be obtained using mechanical preparation, chemical irrigation, and temporary medication of the canal. For this purpose, various irrigation solutions have been advocated. Common root canal irrigants, such as sodium hypochlorite, chlorhexidine, and a mixture of tetracycline, acid, and detergent have been extensively reviewed. The aim of this review was to address the less common newer root canal irrigation solutions, such as citric acid, maleic acid, electrochemically activated water, green tea, ozonated water, and SmearClear.

Influence of ozone and paracetic acid disinfection on adhesion of resilient liners to acrylic resin

PURPOSE

The aim of this study was to evaluate the effect of paracetic acid (PAA) and ozone disinfection on the tensile bond strength (TBS) of silicone-based resilient liners to acrylic resins.

MATERIALS AND METHODS

One hundred and twenty dumbbell shaped heat-polymerized acrylic resins were prepared. From the mid segment of the specimens, 3 mm of acrylic were grinded off and separated parts were reattached by resilient liners. The specimens were divided into 2 control (control1, control7) and 4 test groups of PAA and ozone disinfection (PAA1, PAA7, ozone1 and ozone7; n=10). While control groups were immersed in distilled water for 10 min (control1) and 7 days (control7), test groups were subjected to PAA (16 g/L) or ozone rich water (4 mg/L) for 1 cycle (10 min for PAA and 60 min for ozone) per day for 7 days prior to tensile tests. Measurements of the TBS were analyzed using 3-way ANOVA and Tukey's HSD test.

RESULTS

Adhesive strength of Mollosil decreased significantly by application of ozone disinfection. PAA disinfection had no negative effect on the TBS values of Mollosil and Molloplast B to acrylic resin. Single application of ozone disinfection did not have any negative effect on TBS values of Molloplast B, but prolonged exposure to ozone decreased its adhesive strength.

CONCLUSION

The adhesion of resilient liners to acrylic was not adversely affected by PAA disinfection. Immersion in ozonated water significantly decreased TBS of Mollosil. Prolonged exposure to ozone negatively affects adhesion of Molloplast B to denture base materials.

Efficiency of gaseous ozone in reducing the development of dry socket following surgical third molar extraction

OBJECTIVE

The objective of this study was to assess the efficacy of ozone gas (O3) on the reduction of dry socket (DS) occurrence following surgical extraction of lower jaw third molars, influence of the indication for the extraction, and the difficulty of extraction on the incidence of DS.

MATERIALS AND METHODS

This study included thirty patients with bilaterally impacted third molars of mandible requiring surgical procedure for extraction. Following extraction, in the control group, saline solution was used for irrigation of extraction sockets and in the experimental group, intra-alveolar O3 was applied for 12 s (Prozone, W and H, UK, Ltd.). The surgeries were performed by the same oral surgeon. The follow-up visits were performed at 48 h and on day seven, postsurgery where the symptoms of DS were evaluated and intensity of pain has been recorded using visual analog scale 0-100.

RESULTS

In this pilot study, DS was present in 16.67% and 3.33% of cases in the control and experimental groups, respectively (P = 0.20).

CONCLUSION

The application of O3 may reduce the incidence of DS and accelerates the recovery period after the surgery. Prophylactic use of O3 may be suggested in all patients, especially in the patients at a risk of development of DS.

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.

Management of Chronic Periodontitis Using Subgingival Irrigation of Ozonized Water: A Clinical and Microbiological Study

INTRODUCTION

Adjunctive use of professional subgingival irrigation with scaling and root planing (SRP) has been found to be beneficial in eradicating the residual microorganisms in the pocket.

OBJECTIVE

To evaluate the effect of ozonized water subgingival irrigation on microbiologic parameters and clinical parameters namely Gingival index, probing pocket depth, and clinical attachment level.

MATERIALS AND METHODS

Thirty chronic periodontitis patients with probing pocket depth ≥6mm on at least one tooth on contra lateral sides of opposite arches were included in the study. The test sites were subjected to ozonized water subgingival irrigation with subgingival irrigation device fitted with a modified subgingival tip. Control sites were subjected to scaling and root planing only. The following clinical parameters were recorded initially and after 4 weeks at the test sites and control sites. Plaque Index, Gingival Index, probing pocket depth, clinical attachment level. Microbiologic sampling was done for the test at the baseline, after scaling, immediately after ozonized water subgingival irrigation and after 4 weeks. In control sites microbiologic sampling was done at the baseline, after scaling and after 4 weeks. The following observations were made after 4 weeks. The results were statistically analysed using independent t-test and paired t-test.

RESULT

Test sites showed a greater reduction in pocket depth and gain in clinical attachment compared to control sites. The total anaerobic counts were significantly reduced by ozonized water subgingival irrigation along with SRP compared to SRP alone.

CONCLUSION

Ozonized water subgingival irrigation can improve the clinical and microbiological parameters in patients with chronic periodontitis when used as an adjunct to scaling and root planing.

Effects of ozone nano-bubble water on periodontopathic bacteria and oral cells - in vitro studies

The aims of the present study were to evaluate the bactericidal activity of a new antiseptic agent, ozone nano-bubble water (NBW3), against periodontopathogenic bacteria and to assess the cytotoxicity of NBW3 against human oral cells. The bactericidal activities of NBW3 against representative periodontopathogenic bacteria, Porphyromonas gingivalis (P. gingivalis) and Aggregatibacter actinomycetemcomitans (A. actinomycetemcomitans) were evaluated using in vitro time-kill assays. The cytotoxicity of NBW3 was evaluated using three-dimensional human buccal and gingival tissue models. The numbers of colony forming units (CFUs)/mL of P. gingivalis and A. actinomycetemcomitans exposed to NBW3 dropped to below the lower limit of detection (<10 CFUs mL^-1) after only 0.5 min of exposure. There were only minor decreases in the viability of oral tissue cells after 24 h of exposure to NBW3. These results suggest that NBW3 possesses potent bactericidal activity against representative periodontopathogenic bacteria and is not cytotoxic to cells of human oral tissues. The use of NBW3 as an adjunct to periodontal therapy would be promising.

Antibacterial Efficacy of Aqueous Ozone in Root Canals Infected by Enterococcus faecalis

BACKGROUND

In endodontics, the elimination of resistant bacteria such as Enterococcus faecalis plays an important role for treatment success in root canals. Therefore, new alternative irrigants (instead of sodium hypochlorite) have been researched to achieve ideal endodontic treatment.

OBJECTIVES

The aim of the present study was to evaluate and to compare the antibacterial effect of aqueous ozone with different concentrations and techniques of application (manual and ultrasonic) against E. faecalis in human root canals.

PATIENTS AND METHODS

Eighty single-root mandibular premolar teeth were selected, prepared and sterilized. E. faecalis was incubated in the root canals and kept at 37°C for 24 h. The teeth were divided into four main groups each has 20 members: NaOCl (positive control) group; 8 ppm aqueous ozone group; 12 ppm aqueous ozone group; and 16 ppm aqueous ozone group. While half of the specimens were disinfected with aqueous ozone by manual technique, the other half was disinfected with the aqueous ozone by ultrasonic technique. Conventional irrigation technique was simultaneously applied with ultrasonic vibration that was produced by VDW.ULTRA device. The disinfection procedures were performed for 180 s to ensure standardization of all the working groups. Paper points (placed in the root canals before and after the disinfection procedures) were transferred to Eppendorf tubes containing 0.5 mL of brain heart infusion broth. Then, 50 μL of the suspension was inoculated onto broth agar media. Microbial colonies were counted, and the data were evaluated statistically using 2-way analysis of variance (ANOVA) and Tukey tests.

RESULTS

Although the antibacterial effect of 16 ppm aqueous ozone using a manual technique had an insufficient effect, its ultrasonic application technique resulted in complete disinfection in the root canals.

CONCLUSIONS

The bactericidal activity of high concentration of aqueous ozone combined with ultrasonic application technique showed efficacy similar to that of 5.25% NaOCl in root canals.

Treatment of bisphosphonate related osteonecrosis following root canal therapy at the 1-year follow-up: report of two cases

The objective of this report was to use topical gaseous ozone as an adjunct to conventional treatment methods and to describe the multidisciplinary management of bisphosphonate associated bone necrosis, which developed following endodontic treatment. No complaints were noted by the patients at their 1-year follow-up and the treatment showed favorable prognosis.

The antimicrobial effect of 0.1 ppm ozonated water on 24-hour plaque microorganisms in situ

Ozone is a known oxidant present in the atmosphere and is commercially produced by simple ozonizer machines. It is a powerful antimicrobial agent in its gaseous and aqueous forms. Ozone readily dissolves in water and retains its antimicrobial property even in the dissolved state. In this study, the effect of 0.1 ppm ozonated water was analyzed on 24-hour supragingival plaque (SP) samples in situ. SP was collected from the two most posterior teeth in the contra-lateral quadrants before and after a 30-second rinse with either distilled water (control group) or 0.1 ppm ozonated water (test group). The plaque was used to count the number of total bacteria, total anaerobic bacteria, Streptococcus mutans, and Candida albicans on selective agar media. The statistical analysis of the number of colony forming units (CFUs) obtained demonstrated a significant antimicrobial effect of ozonated water on the total bacteria (p = 0.01) and anaerobes (p = 0.02). A reduction in the post-rinse CFU count for Streptococcus mutans was also observed, but the effect was not statistically significant (p = 0.07). The Candida species was only grown from one sample. Ozonated water at the 0.1 ppm concentration was effective in reducing the load of 24-hour plaque bacteria, but it did not eliminate them completely.

Effect of different disinfectant methods on the initial microtensile bond strength of a self-etch adhesive to dentin

The aim of this in vitro study was to evaluate the effect of different disinfection methods on the initial microtensile bond strength of a two-step, self-etch adhesive to dentin. Twenty mandibular molars were sectioned parallel to the occlusal plane to expose the mid-coronal dentin. All of the teeth were divided into four groups (n = 5 per group): (1) in group OZ, the dentin surfaces were exposed to ozone gas from the Ozonytron X delivery system (OzonyTron X-Bioozonix, Munich, Germany), (2) in group ND, the dentin surfaces were irradiated with an Nd:YAG laser (Pulsmaster 600 IQ, American Dental Technologies, U.S.), (3) in group CHX, the dentin surfaces were treated with a 2% chlorhexidine solution, and (4) in the control group, no treatment was applied. In all of the groups, the teeth were restored with Clearfil SE Bond (Kuraray, Tokyo, Japan) and Clearfil Majesty Posterior (Kuraray, Tokyo, Japan), according to the manufacturer's instructions. The teeth were sectioned perpendicular to the bonded surface (surface area of approximately 1 mm(2)). Thus, six to seven specimens were obtained from each tooth, and a total of 34 specimens were analyzed in each group. The specimens were attached to the microtensile test machine (Micro Tensile Tester, T-61010 K, Bisco, U.S.). The data was analyzed using the one-way analysis of variance (ANOVA) and Tukey test (p < 0.05). Fracture modes of each specimen were determined using a stereomicroscope (SZ-PT Olympus, Tokyo, Japan) and a scanning electron microscope (SEM). The lowest bond strength occurred in the OZ group. Significant differences were determined only between group OZ and the other groups (group ND, group CHX, and control group) (p < 0.05). In conclusion, although ozone decreased the microtensile bond strength of the self-etch adhesive system to dentin, the Nd:YAG laser and 2% chlorhexidine did not change the microtensile bond strength so in context of the present study it would appear that the Nd:YAG laser and 2% chlorhexidine may be used as pre-restorative sterilization procedures on the dentin prior to the application of a two-step, self-etch adhesive.