Ozone Therapy in Medicine and Dentistry: A Review of the Literature

Comparison of microbubbling and conventional bubbling methods for ozonated saline solution in CKD patients: a pilot study

Chronic kidney disease (CKD) is a progressive condition marked by persistent kidney damage, leading to high mortality rates and economic burden in advanced stages. Ozone therapy has emerged as a complementary alternative capable of mitigating oxidative stress involved in CKD progression. Ozonated saline solution (OSS) prepared via microbubbling offers enhanced efficacy due to greater ozone dissolution, homogeneity, and stability compared to conventional methods. This study compared the biosafety and efficacy of OSS prepared through bubbling and microbubbling methods in advanced CKD patients. In vitro, hydrogen peroxide (H2O2) concentrations were measured at various doses and times for both methods. In healthy volunteer, biosafety was assessed using TMRE and Annexin V in leukocytes. In CKD patients, TMRE, Annexin V, redox markers (catalase, superoxide dismutase, glutathione system, H2O2, lipoperoxidation), and renal function markers (urea, creatinine, glomerular filtration rate) were evaluated. Microbubbling produced lower H2O2 concentrations in vitro, depending on time and ozone dose. In vivo, both methods increased mitochondrial activity and apoptosis in CKD patient leukocytes. However, microbubbling notably enhanced antioxidant capacity, catalase and superoxide dismutase activity, and redox balance (elevated reduced-to-oxidized glutathione ratio) compared to conventional bubbling. It also showed slight improvements in serum clinical parameters. In conclusion, the microbubbling method demonstrated superior biosafety and therapeutic efficacy in advanced CKD patients, highlighting its potential as a preferred approach in ozone therapy.

Efficacy of ozone therapy in dentistry with approach of healing, pain management, and therapeutic outcomes: a systematic review of clinical trials

Ozone therapy has emerged as a promising treatment modality in dentistry due to its antimicrobial and healing properties. This systematic review aimed to evaluate the recent clinical trials on ozone therapy in dentistry and its impact on therapeutic outcomes. A comprehensive literature search was conducted across multiple databases, including Web of Science, PubMed, and Scopus from January 2018 to December 2024, identifying studies that investigated the use of ozone in dental applications. The findings demonstrated that ozone therapy is effective in improving periodontal health, healing soft tissue after dental implant surgery, and reducing postoperative discomfort. The combination of scaling and root planing with gaseous ozone therapy showed superior periodontal response rates. The use of ozone during endodontics procedures resulted in reduced post-treatment pain, while ozonated materials showed promise in the management of dentinal hypersensitivity. However, it is not recommended in restorative dentistry due to potential adverse effects on dentinal bond strength. The findings of this systematic review supported the integration of ozone therapy into dentistry as an adjunctive therapy. More research is needed to elucidate its mechanisms, optimize application techniques, and evaluate long-term outcomes for patient safety and treatment effectiveness.

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

BACKGROUND

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

METHODS

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

RESULTS

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

CONCLUSION

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

Ozone-Oxygen Therapy to Prevent HPV-Related Cancers of the Lower Gynecological Tract in Infected Patients: The Rationale for Further Developments

BACKGROUND

O3-O2 therapy is an alternative medical treatment that introduces a mixture of O3-O2 into the body for therapeutic purposes. The objective of this study is to evaluate its margins of applicability in the eradication of HPV infection from the lower gynecological tract by means of vaginal insufflation.

METHODS

An in-depth review of the international literature on this topic is carried out; in addition, O3-O2 therapy is compared with other treatments currently available in terms of its advantages, disadvantages, and exploited technologies.

RESULTS

The possible benefits and limitations of O3-O2 vaginal insufflation are explained in detail; overall, it appears to be an interesting tool as part of complex management to prevent HPV-related cancers of the lower gynecological tract in infected patients.

CONCLUSIONS

The rationale and guidelines of this innovative procedure have been successfully illustrated, providing the technical specifications for further developments.

The Impact of Ozone on Periodontal Cell Line Viability and Function

Periodontal diseases, including gingivitis and periodontitis, are chronic inflammatory conditions of the teeth' supporting structures that can lead to progressive tissue destruction and loss if left untreated. Basic treatments like scaling and root planing, alone or combined with antimicrobial agents, are the standard of care. However, with the increasing prevalence of antibiotic resistance and the need for new ideas in therapy, adjunctive treatments like ozone therapy have gained attention. Ozone (O3), a triatomic oxygen molecule, is used because of its strong antimicrobial, anti-inflammatory, and regenerative activity and, hence, as a potential tool in periodontal therapy. This review of the use of ozone therapy in periodontal disease breaks down the multifaceted mechanism of ozone therapy, which includes the selective antimicrobial action against biofilm-associated pathogens, immunomodulatory effects on host cells, and stimulation of tissue repair. O3 therapy disrupts microbial biofilms, enhances immune cell function, and promotes healing by activating Nuclear Factor Erythroid 2-Related Factor 2 (Nrf2) and Mitogen-Activated Protein Kinase (MAPK) signaling pathways that regulate oxidative stress, inflammation, and apoptosis. Additional findings include its ability to upregulate growth factors and extracellular matrix proteins, which is significant for periodontal tissue regeneration. This review also discusses the application of O3 therapy in periodontal cell lines, emphasizing its impact on cell viability, proliferation, and differentiation. Advances in periodontal regenerative techniques, combined with the antimicrobial and healing properties of O3, have demonstrated significant clinical benefits. Challenges, including the need for standardized dosages, effective delivery systems, and long-term studies, are also addressed to ensure safe and effective clinical integration. O3 therapy, with its dual antimicrobial and regenerative capabilities, offers an innovative adjunctive approach to periodontal treatment. Future research focusing on optimized protocols and evidence-based guidelines is essential to fully realize its potential in enhancing periodontal health and improving patient outcomes.

The histopathologic evaluation of local effects of ozone therapy on the healing of experimental calvarial defects of rats

BACKGROUND

This study evaluates the effects of ozone on hard and soft tissue healing when a free tissue flap is used to close wound areas lacking primary closure over autogenous grafted sites.

METHODS

In our study, 24 male Wistar rats were divided into four groups: two control groups and two ozone-treated groups. All rats underwent the same surgical procedure. After surgery, the control groups received no additional treatment, while the ozone groups received topical ozone application. Ozone was applied for 2 min, three times per week, with one-day intervals, for a duration of 2 weeks post-surgery. Sacrifice was performed on the 14th day for one control and one ozone group, and on the 28th day for the remaining groups. All soft and hard tissue samples were then examined histopathologically.

CLINICAL TRIAL NUMBER

not applicable.

RESULTS

Histopathological evaluations and statistical analyses on the 14th day indicated that bone healing was significantly better in the ozone group compared to the control group (p = 0.049). For soft tissue healing, although there was no statistically significant difference between the ozone and control groups, proportional values showed better recovery in the ozone-treated groups compared to the controls.

CONCLUSIONS

The present study concludes that ozone has a positive effect on new bone formation in the early stages; however, it showed no statistically significant effect on soft tissue healing. We believe that further comprehensive studies would be beneficial to confirm these findings.

Interaction effects of exposure to air pollution and social activities on cognitive function in middle-aged and older Chinese adults based on a nationwide cohort study

BACKGROUND

Although there have been many studies on the relationship between ambient air pollution and cognitive functioning in developed countries, there are no studies focusing on the interaction between ambient air pollution and social activities. This study aims to examine interactive effects of ambient air pollution and social activities on cognitive function in Chinese middle-aged and older.

METHODS

This study used nationally representative longitudinal survey data of China Health and Retirement Longitudinal Study (CHARLS) 2013, 2015 and 2018. The study explored the additive interaction effects of air pollutants and social activities on cognitive function in middle-aged and older adults by constructing mixed linear regression analyses containing interaction terms, as well as constructing additive interaction analyses with dummy variables containing four unordered categories that were partitioned according to median. In addition, the study further explored the interaction between air pollution and different types of social activities through an interaction term between air pollution and different types of social activities.

RESULTS

In the model fully adjusted for covariates such as age, sex, region, we found significant coefficients on the interaction term between PM2.5, O3 and social activities on cognitive function (PM2.5, β = -0.018, 95%CI: -0.029, -0.006; O3, β = 0.017, 95%CI: 0.007, 0.027). In the interaction analysis by constructing dummy variables, we found a significant antagonistic effect between PM2.5 and social activities (SI = 0.730, 95%CI: 0.674, 0.785), a possible antagonistic effect between NO2 and social activities (SI = 0.697, 95%CI: 0.648, 0.747), and a possible synergistic effect between O3 and social activities (SI = 1.769, 95%CI: 0.648, 0.747). In addition, the study found significant interactions between simple interaction, leisure and recreational, and intellectual participation social activities and air pollution.

CONCLUSION

Our study demonstrated an antagonistic effect of PM2.5 and social activities on cognitive function in middle-aged and older Chinese adults.

Low-Dose Ozone as a Eustress Inducer: Experimental Evidence of the Molecular Mechanisms Accounting for Its Therapeutic Action

Ozone (O3) is an unstable, highly oxidative gas that rapidly decomposes into oxygen. The therapeutic use of O3 dates back to the beginning of 20th century and is currently based on the application of low doses, inducing moderate oxidative stress that stimulates the antioxidant cellular defences without causing cell damage. In recent decades, experimental investigations allowed the establishment of some basic mechanisms accounting for the therapeutic effects of eustress-inducing low-dose O3. In this review, special attention was given to the impact of O3 administration on the cell oxidant-antioxidant status, O3 anti-inflammatory and analgesic properties, efficacy in improving tissue regeneration, and potential anticancer action. Low O3 concentrations proved to drive the cell antioxidant response mainly by activating nuclear factor erythroid 2-related factor 2. The anti-inflammatory effect relies on the downregulation of pro-inflammatory factors and the modulation of cytokine secretion. The painkilling action is related to anti-inflammatory processes, inhibition of apoptosis and autophagy, and modulation of pain receptors. The regenerative potential depends on antioxidant, anti-inflammatory, anti-apoptotic, and pro-proliferative capabilities, as well as fibroblast activation. Finally, the anticancer potential is based on oxidant and anti-inflammatory properties, as well as the inhibition of cell proliferation, invasion, and migration and the induction of apoptosis.

Unveiling the Therapeutic Potential of Systemic Ozone on Skin Wound Repair: Clinical, Histological, and Immunohistochemical Study in Rats

This study sought to examine the effects of systemic ozone (O3) treatment on the healing of skin wounds induced on the dorsal surface of Wistar rats. The skin wounds were created using a 10 mm round punch following the sagittal medial plane in 72 rats. Then, the animals were randomly assigned to four groups, each receiving the following treatments: group C, which did not undergo treatment with the O3/O2 mixture; group OZ0.3, administered the O3/O2 mixture at a dose of 0.3 mg/kg; group OZ0.7, given the O3/O2 mixture at a dose of 0.7 mg/kg; and group OZ1.0, provided with the O3/O2 mixture at a dose of 1.0 mg/kg. Six animals from each group were euthanized at 7, 14, and 21 days postoperatively. Clinical, histological, histometric, and immunohistochemical (IHC) analyses were accomplished. Data from clinical and histometric assessments revealed that OZ0.7 and OZ1.0 demonstrated more favorable healing, with greater wound contraction observed in the OZ1.0 group at 14 and 21 days. Histologically, the OZ1.0 group exhibited aspects consistent with an accelerated tissue repair process. IHC analysis revealed greater vascular endothelial growth factor (VEGF) immunostaining in the OZ0.7 (7 days) and OZ1.0 (7 and 14 days) groups compared to the C group. Expression of transforming growth factor beta-1 was significantly increased in the OZ0.7 (14 days) and OZ1.0 (7 and 14 days) groups compared to the C group. In conclusion, our data suggest that systemic use of O3 enhanced tissue repair in cutaneous wounds in a dose-dependent manner, with concentrations of 1.0 mg/kg providing the most beneficial effects. Furthermore, the results of this study implicate the use of O3 for the treatment of skin wounds aiming at improving the healing process over time. Our findings suggest the use of O3 as a viable alternative to enhance wound healing and repair.

Ozone therapy in dentistry: An overview of the biological mechanisms involved (Review)

At low medically-relevant concentrations, ozone serves as an oxidant with a wide spectrum of antimicrobial activity and the ability to promote healing and reduce inflammation. Despite providing therapeutic benefits in a range of diseases, certain adverse effects and contraindications of ozone treatment must be considered. These are primarily related to toxicity from inhalation and systemic types of administration and can be avoided by following relevant guidelines and recommendations. Ozone therapy has been implemented in a number of fields of dentistry and the most commonly used formulations for the oral cavity are gaseous ozone, ozonized water and ozonized oil. The biological mechanisms underlying the molecular effects of ozone have been increasingly reported, but currently remain largely unknown. The aim of the present review was to provide an overview of the mechanisms involved in ozone interaction with dental tissues. The present review focused on relevant evidence regarding the effect of ozone on dental tissues, including periodontal structures, dental cells, enamel and dentine, considering in vitro studies in addition to animal and human studies. A variety of biological mechanisms acting through multiple biochemical target pathways were reported to be responsible for the therapeutic effects of ozone. The main beneficial effects of ozone occurred in the following domains: antimicrobial activity, remineralization and microstructural changes of hard dental tissues, immunomodulation and biostimulation of dental and periodontal cells. Additional research could provide further insights into the use of ozone, increase its use for broader clinical applications and assist in the selection of targeted protocols.

Effects of plasma surface treatment on the bond strength of zirconia with an adhesive resin luting agent

The purpose of this study was to evaluate the effect of the atmospheric pressure plasma treatment as a surface treatment method on the contact angle and shear bond strength (SBS) of zirconia ceramics and the failure mode between the self-adhesive resin luting agent and zirconia. The zirconia specimens were divided into eight groups based on the surface treatment method: alumina blasting, air plasma, argon plasma (AP), Katana cleaner, ozonated water, ozonated water+AP, Katana cleaner+AP, and tap water+AP. The contact angles, SBS, and fracture modes were tested. AP treatment significantly reduced the contact angle (p<0.0001). The combination of AP and other cleaning methods showed a higher bond strength and more mixed fractures. Our findings indicate that using atmospheric pressure plasma with argon gas, combined with other cleaning methods, results in a stronger bond than when using alumina blasting alone.

Ozone therapy in musculoskeletal medicine: a comprehensive review

Musculoskeletal disorders encompass a wide range of conditions that impact the bones, joints, muscles, and connective tissues within the body. Despite the ongoing debate on toxicity and administration, ozone demonstrated promise in managing several musculoskeletal disorders, modulating pain and inflammation. A literature search was conducted. The research design, methods, findings, and conclusions of the studies were then examined to evaluate the physiological effects, clinical application, controversies, and safety of the application of ozone in musculoskeletal medicine. Ozone application demonstrates considerable therapeutic applications in the management of musculoskeletal disorders, including fractures, osteoarthritis, and chronic pain syndromes. Despite these advantages, studies have raised concerns regarding its potential toxicity and emphasized the importance of adhering to stringent administration protocols to ensure safety. Additionally, heterogeneities in patient reactions and hazards from oxidizing agents were observed. Given its anti-inflammatory and analgesic qualities, ozone therapy holds potential in the management of several musculoskeletal disorders. Additional high-quality research with long follow-up is required to refine indications, efficacy and safety profile. Finally, for wider clinical acceptability and utilization, the development of international recommendations is essential.

Gaseous ozone and ozonized mist in the control of Escherichia coli on 'Rama Forte' persimmon

This study aimed to evaluate the effectiveness of using two ozone applications (gaseous and mist) as a disinfection method for fresh persimmon. To test these sanitizers, in vitro and in vivo assays were performed, and the Escherichia coli was selected because it is a pathogen that causes foodborne diseases in humans. For in vitro experiments, a plate was inoculated with Escherichia coli strain ATCC 25922 and treated. For in vivo assays, persimmon fruit surface was inoculated with the bacteria and treated. For both assays, it was used 10,15,20,30,40 and 50 μL L-1 of gaseous ozone or ozonized mist for five minutes. The results demonstrated that the gas ozone application significantly reduced the growth of E. coli on the plate surface in vitro at doses of 30, 40 and 50 μL L-1 (with 0.83, 0.89 and 0.95 log CFU mL-1, respectively). The application of ozonized mist showed a significant reduction for 50 μL L-1 (with 1.28 log CFU g-1). And, for the in vivo assays, ozonized mist significantly reduced the number of bacteria on the persimmon surface, with a 1.57 log reduction, which was the largest for 40 μL L-1. Therefore, it is possible to conclude that the ozone application can contribute to the control of microorganisms present on fruit surfaces.

Effects of systemic ozone administration on the fresh extraction sockets healing: a histomorphometric and immunohistochemical study in rats

OBJECTIVE

Studies have highlighted numerous benefits of ozone therapy in the field of medicine and dentistry, including its antimicrobial efficacy against various pathogenic microorganisms, its ability to modulate the immune system effectively, reduce inflammation, prevent hypoxia, and support tissue regeneration. However, its effects on dental extraction healing remain to be elucidated. .Therefore, this study aimed to evaluate the effects of systemically administered ozone (O3) at different doses in the healing of dental extraction sockets in rats.

METHODOLOGY

To this end, 72 Wistar rats were randomly divided into four groups after extraction of the right upper central incisor: Group C - control, no systemic treatment; Group OZ0.3 - animals received a single dose of 0.3 mg/kg O3; Group OZ0.7 - a single dose of 0.7 mg/kg O3; and Group OZ1.0 - a single dose of 1.0 mg/kg O3, intraperitoneally. In total, six animals from each group were euthanized at 7, 14, and 21 days after the commencement of treatment. Bone samples were harvested and further analyzed by descriptive histology, histomorphometry, and immunohistochemistry for osteocalcin (OCN) and tartrate-resistant acid phosphatase (TRAP) protein expression.

RESULTS

All applied doses of O3 were shown to increase the percentage of bone tissue (PBT) after 21 days compared to group C. After 14 days, the OZ0.7 and OZ1.0 groups showed significantly higher PBT when compared to group C. The OZ1.0 group presented the most beneficial results regarding PBT among groups, which denotes a dose-dependent response. OCN immunostaining was higher in all groups at 21 days. However, after seven and 14 days, the OZ1.0 group showed a significant increase in OCN immunostaining compared to C group. No differences in TRAP+ osteoclasts were found between groups and time points.

CONCLUSION

Therefore, O3 therapy at higher doses might be beneficial for bone repair of the alveolar socket following tooth extraction.

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

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

Oral Implantology: Current Aspects and Future Perspectives

In recent years, dental implantology has significantly improved with the development of more advanced techniques which have greatly increased the reliability of dental implant therapy while reducing patient morbidity [...]

Apoptosis Regulation in Dental Pulp Cells and PD-1/PD-L1 Expression Dynamics Under Ozone Exposure - A Pilot Approach

This study aimed to determine the effect of ozone on the expression of Bax and Bcl-2 genes in dental pulp cells. Additionally, the programmed cell death protein 1, programmed death-ligand 1, and CD200 antigens were determined in lymphocytes to assess their surface expression. Dental pulp cells were cultured from extracted healthy third molars and characterized as dental pulp stromal cells. Gene expression of Bcl-2 and Bax was analyzed at 0 s, 6 s, and 12 s of ozone exposure using real-time PCR. Lymphocytes from dental pulp were subjected to ozone exposure for 12 s and PD-1, PD-L1, and CD200/CD200R expression was analyzed by flow cytometry. Upon exposure to ozone for 6 s, the Bcl-2 expression decreased significantly to -0.09, and at 12 s, it increased significantly to 0.3. Bax gene expression level increased significantly to 0.188 after 6 s exposure, and at 12 s, to 0.16. Lymphocytes exposed to ozone for 12 s showed minimal changes in PD-1, PD-L1, and CD200/CD200R expression levels, indicating that oxidative stress does not impact the signaling pathways regulating these molecules. The significant upregulation of Bcl-2 at 12 s highlights the cells' effort to protect themselves from prolonged oxidative stress, possibly tipping the balance toward cell survival and tissue repair. However, the absence of changes in PD-1 and PD-L1 expression on lymphocytes under oxidative stress suggests that these molecules are not sensitive to oxidative stress in this context.

Selected possibilities of physical medicine versus cancer diseases

OBJECTIVE

Aims: This review aims to synthesize the latest literature on physical treatments for wounds, focusing on the use of ozone therapy, topical oxygen therapy, pulsed electromagnetic field therapy, and red light therapy in oncology patients. It evaluates the indications, benefits, and contraindications of these therapies, especially concerning cancer..

PATIENTS AND METHODS

Materials and Methods: A literature search was conducted in publicly available online databases, covering publications in English and Polish from 2010 to 2024. The inclusion criteria comprised clinical trials, systematic reviews, meta-analyses, and review articles on physical treatments for wounds in oncology patients. The selection process involved pre-selection, title and abstract review, and full-text review to ensure compliance with the inclusion criteria. Data were analyzed to identify mechanisms of action, therapeutic efficacy, and potential risks associated with these therapies in oncology patients. Ozone therapy showed potential in reducing bacterial load and tumor hypoxia, enhancing chemotherapy efficacy. Topical oxygen therapy was effective for chronic wounds, with careful application near tumor sites. Pulsed electromagnetic field therapy demonstrated promising anticancer effects, inducing apoptosis in cancer cells. Red light therapy, while beneficial for managing side effects of cancer treatments, was contraindicated in areas with active tumors due to the risk of stimulating cancer cell proliferation.

CONCLUSION

Conclusions: Physical therapies offer benefits in wound management but require careful consideration in oncology patients. Personalized evaluation and further research are essential to establish safe and effective protocols for oncology patients, maximizing therapeutic benefits while minimizing risks.