Clinical utility of ozone therapy in dental and oral medicine

Effect of sanitizing solutions on cobalt chromium alloys for dental prostheses: A systematic review of in vitro studies

STATEMENT OF PROBLEM

Given the wide use of cobalt chromium (Co-Cr) alloys, especially for removable partial dentures, and the importance of chemical solutions to complement the cleaning of dental prostheses, safe disinfection products should be identified for the regular decontamination of Co-Cr dental prostheses.

PURPOSE

The purpose of this systematic review of in vitro studies was to determine the effects on the properties of Co-Cr dental alloys of the various chemical agents used to clean dental prostheses.

MATERIAL AND METHODS

In vitro studies were included based on a literature search conducted in March 2022 in the Medline/PubMed, SCOPUS, Web of Science, Virtual Health Library, and Embase databases. Independent reviewers performed the search, selection, extraction, and analysis of the data. The review was performed based on the Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) guidelines. The quality of the included articles was evaluated by using parameters adapted from the Consolidated Standards of Reporting Trials (CONSORT) guidelines, and the risk of bias analysis was performed based on previous studies.

RESULTS

Among the 15 included studies, the chemical agents evaluated were alkaline peroxides and hypochlorites, mouthwashes containing cetylpyridinium chloride and chlorhexidine, diluted acids, and enzymes. Some peroxides produced increased ion release, surface roughness, and mass loss of the alloys. The hypochlorites were responsible for the greatest surface corrosion, yielding dark stains, rough regions, and depressions. Acetic and peracetic acids and mouthwashes containing chlorhexidine and cetylpyridinium did not produce significant changes in Co-Cr alloys. Most studies presented moderate risk of bias.

CONCLUSIONS

According to the included studies, mouth rinses containing cetylpyridinium chloride or chlorhexidine and solutions with acetic and peracetic acid could be safely used to chemically sanitize Co-Cr prostheses. Alkaline peroxides should be used with caution, and alkaline hypochlorite solutions should be avoided.

Ozonized gels vs chlorhexidine in non-surgical periodontal treatment: A randomized clinical trial

OBJECTIVE

To evaluate the efficacy of newly introduced ozonated gels compared with conventional chlorhexidine gel in the home management of periodontal patients.

MATERIALS AND METHODS

30 patients with bilateral periodontal disease (severity I, complexity II) were enrolled (split-mouth study design). After nonsurgical mechanical periodontal debridement, the teeth were randomly divided into two groups: teeth in the Control group were treated with a chlorhexidine-based gel to aid oral hygiene maneuvers for 2 weeks after the first visit, while teeth in the Test group were treated in the same way with ozone-based gels. After the baseline assessment, the follow-up included assessments at 1, 2, and 6 months. The variables evaluated were clinical attachment loss (CAL), probing pocket depth (PPD), bleeding on probing (BoP), plaque control record (PCR), recession (R), and tooth mobility (TM).

RESULTS

For CAL, PPD, BoP, and PCR, significant intragroup differences were found for both groups (p < 0.05), in contrast to intergroup differences (p > 0.05). No significant differences were found for R and TM.

CONCLUSION

Nonsurgical mechanical periodontal debridement with adjunctive use of ozone and chlorhexidine was found to be effective in periodontal treatment. Ozone could be suggested as an alternative to chlorhexidine.

The Management of Necrotizing Gingivitis in Paediatric Patients: A Scoping Review and Two Case Reports

Necrotizing gingivitis (NG) is an acute inflammatory process with an estimated prevalence of less than 1%. The treatment of choice is usually antibiotics in addition to periodontal treatment. This scoping review aims to detail extent and type of proof related to NG in paediatric patient; moreover, a decision tree protocol was developed to define NG management in paediatric patients based on the presence or absence of systemic compromission. In addition, we also propose the use of ozone treatment as an adjuvant therapy. Seven papers (3 case reports, 2 guidelines, and 2 reviews) were selected for evaluation by reading the full texts. This review outlines the lack of research on the treatment of NG in paediatric patients; we, however, demonstrate the efficacy of the decision tree protocol by describing two case reports in which patients were treated with antibiotics according to the presence or absence of systemic involvement through the implementation of an individualized therapeutic approach, with periodontal ozone therapy. Moreover, the supportive use of this molecule in the management of NG can be a valuable tool in the healing of gingival tissues.

Piezoelectric Surgery, Er:YAG Laser Surgery and Nd:YAG Laser Photobiomodulation: A Combined Approach to Treat Medication-Related Osteonecrosis of the Jaws (MRONJ)

Medication-related osteonecrosis of the jaw (MRONJ) is a drug complication that can occur in patients taking antiresorptive or antiangiogenic drugs. Although it is a well-documented disease, there is no widely accepted treatment. However, several therapeutic approaches have been proposed. The surgical approach in many advanced cases appears inevitable; however, the results are not yet defined and predictable. This study aimed to propose a combined surgical approach with a piezoelectric device and laser (Er:YAG for bone ablation and Nd:YAG laser for photobiomodulation) in a young patient with breast cancer and bone metastasis under denosumab treatment, affected by spontaneous stage 3 MRONJ with maxillary sinus involvement. The patient under study reported no post-operative discomfort, with painkiller intake limited to the day after surgery. Total mucosal healing was observed without recurrences for more than 4 years after surgery. According to the results of our preliminary study, a combined surgical approach using a piezoelectric device and laser therapy is effective in managing patients affected by MRONJ, leveraging the clinical and biological advantages of these different techniques.

Efficacy of ozone therapy for oral mucosa wound healing: a systematic review and meta-analysis

OBJECTIVES

To conduct a systematic review and meta-analysis to assess the effectiveness of ozone therapy in oral ulcers healing when compared to placebo or active treatments.

MATERIALS AND METHODS

The search was carried out using PubMed, EMBASE, Scopus, and Lilacs databases. Clinical trials involving human participants were included. The Risk Ratio (RR) and the standardized mean difference (SMD) with 95%CI (confidence interval) were calculated. The ROBINS-I (risk of bias in non-randomized studies of interventions) and RoB2 (risk of bias tool for randomized trials) assessment tool was used to detect bias.

RESULTS

After the selection process, 12 studies were included. The meta-analysis showed that ozone therapy helps to reduce the size of the traumatic and autoimmune ulcers (RR=-0.44; 95% CI -0.71,-0.17; I2=0%) in comparison to placebo. Regarding pain reduction, ozone was superior to placebo (RR = 1.29, 95% CI -1.6 to -0.95); I2=0%), and equivalent to topical corticosteroid and laser photobiomodulation (RR = 0.26, 95% CI -0.27,0.78, p = 0.34).

CONCLUSION

Ozone therapy is an alternative for accelerating healing and reducing pain for both traumatic and autoimmune ulcers. However, the quality of evidence is limited.

CLINICAL RELEVANCE

Oral ulcerations are usually painful and impact quality of life requiring different approaches to boost wound healing and reduce symptoms. For this purpose, ozone therapy is a promising strategy.

Antibacterial Effect of Ozone on Cariogenic Bacteria and Its Potential Prejudicial Effect on Dentin Bond Strength-An In Vitro Study

Ozone is increasingly utilized in dental caries treatment due to its antibacterial properties. In a context of limited studies and no consensus on protocols, this research aims to assess ozone's antibacterial efficacy on cariogenic bacteria and its potential adverse impact on dentin bond strength. Streptococcus mutans, Streptococcus sobrinus, Lactobacillus casei, and Actinomyces naeslundii suspensions were exposed to 40 μg/mL of ozone gas and 60 μg/mL of ozonated water (80 s) via a medical ozone generator. Negative and positive control groups (chlorhexidine 2%) were included, and UFC/mL counts were recorded. To examine microtensile bond strength (µTBS), 20 human molars were divided into four groups, and class I cavities were created. After ozone application, samples were restored using an etch-and-rinse and resin composite, then sectioned for testing. The SPSS v. 28 program was used with a significance level of 5%. The µTBS results were evaluated using one-way ANOVA, Tukey HSD, and Games-Howell. Bacterial counts reduced from 106 to 101, but dentin µTBS was significantly impacted by ozone (ANOVA, p < 0.001). Despite ozone's attractive antibacterial activity, this study emphasizes its detrimental effect on dentin adhesion, cautioning against its use before restorative treatments.

Ozone and Laser Effects on Dentin Hypersensitivity Treatment: A Randomized Clinical Study

INTRODUCTION

The aim of this study was to evaluate and compare the clinical efficacy of diode laser and ozone gas in the treatment of dentin hypersensitivity (DHS).

METHODS

One hundred thirty-two teeth from 44 patients with moderate DHS were randomized into 3 groups according to a split-mouth design. In the diode laser group, the operator irradiated the superficial dentin exposed with an 808-nm wavelength and incremental power from 0.2 to 0.6 W with a 20-second interval. In the ozone gas group, the operator applied a high dose of ozone (32 g/m3) for 30 seconds using a silicon cup. In the placebo group, no therapy was applied. The dentin sensitivity level was evaluated upon enrollment (T0), immediately after treatment (T1), 3 months post-treatment (T2), and 6 months post-treatment (T3) with a cold air blast challenge and tactile stimuli. The pain severity was quantified according to the visual analogue scale. The Wilcoxon signed rank test was used to scrutinize potential statistical disparities among the treatments. Statistical significance was predetermined at P < .05.

RESULTS

A significant decrease of DHS was observed in the ozone gas group and the `diode laser group immediately after treatment and after 3 and 6 months of the therapy. After 6 months from the therapy, the sensitivity values in the teeth treated with ozone gas remained statistically lower than those treated with diode lasers (P < .05).

CONCLUSIONS

A laser diode and ozone gas are both efficient as dentin sensitivity treatment. Ozone maintains an invariable effectiveness after 6 months.

Ozone treatment combined with sodium fluoride for the treatment of dentin hypersensitivity: an exploratory study

BACKGROUND

Dentin hypersensitivity is one of the most common complains faced by dental professionals, and there is still lack of consensus for the most effective treatment approaches. The aim of the present study was to evaluate the efficacy of ozone therapy combined with sodium fluoride in reducing pain associated with dental hypersensitivity, compared to a paint-on adhesive desensitizing agent.

METHODS

The study included 20 patients (131 teeth), selected according to specific inclusion criteria and divided into two groups according to the type of desensitizing therapy (ozone with sodium fluoride or paint-on adhesive). The efficacy of both treatments were evaluated recording pain for each treated tooth immediately after treatment, after 1 month and after 6 months using a Numeric Rating Scale (NRS). Subjective parameters were also recorded: patients were asked to report whether they experienced pain caused by air, teeth brushing, cold and hot topical stimuli (present/absent).

RESULTS

In both groups, pain values significantly decreased over time. Six months after treatment we registered significantly lower pain values in the ozone-treated group compared with the adhesive group and the mean percentage of NRS reduction from was significantly higher in the ozone-treated group. We did not register significant differences in subjective pain-related parameters between groups.

CONCLUSIONS

The results of this exploratory study were aimed at exploring the combined effect of ozone with natrium fluoride, which was before described only in vitro. With the limitation of the sample size, our results suggest that this approach provides a pain reduction that was comparable to the paint-on adhesive.

Ozone: An Adjunct in Dental Treatment

Ozone is utilized in dentistry as ozonated oils, ozonated water, and gaseous ozone. The application of ozone in all specialties of dentistry has been demonstrated to be biocompatible. It has been demonstrated to encourage the remineralization of recently carious teeth, and it is utilized in dental caries and intracanal irrigants in endodontic treatment. Herpes virus infection, avascular osteonecrosis of the jaw, and alveolitis have all been treated with it. It can be applied as a supplement in the surgical and ongoing stages of periodontal disease and also hinders plaque formation. The purpose of the present review article is to discuss the numerous application of ozone in dentistry.

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

Background

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

Methods

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

Results

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

Conclusion

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

Effectiveness of Topical Ozone Gel Application in the Management of Postextraction Wound Healing: An In Vivo Study

AIM

The purpose of the current study was to determine the effectiveness of topical ozone gel application in the management of postextraction wound healing.

MATERIALS AND METHODS

The current study involved a total of 40 participants. The patients were randomly placed into two groups with sample size estimated as n = 20 in each group. Group A: Control: patients received only saline irrigation and group B: patients receiving topical ozone gel. The surgical procedure was standardized for all groups, and local anesthesia was used during the procedure. After the removal of the mandibular third molar, the control group irrigated the socket with saline, whereas in the study group, the socket was filled with ozone gel. On the first, third, fifth, and seventh postoperative days, a single examiner evaluated each participant for postoperative mouth opening, discomfort, and patient satisfaction. The t-test was used to analyze quantitative data, whereas the Fisher exact test was employed to analyze qualitative data. Statistical significance was defined as a p value less than 0.05.

RESULTS

On comparison of patient satisfaction, in the ozone gel group, 13 patients were very satisfied but in the control group, 8 patients were very satisfied. On comparison of pain intensity, on the 5th day, the complete absence of pain patients was more in the ozone gel group (12 patients) compared with the control group (4 patients). There was a statistically significant difference found between these two groups (p < 0.001). On comparison of mouth opening, on the 3rd and 5th day, mouth opening was better in the ozone gel group (29.22 ± 1.28 and 34.06 ± 0.09) compared with the control group (27.38 ± 1.03 and 31.14 ± 0.82), respectively. And there was a statistically significant difference found between these two groups (p < 0.001) on both the days.

CONCLUSION

The current study came to the conclusion that using ozone gel significantly improves postoperative pain, mouth opening range, and promotes faster wound healing.

CLINICAL SIGNIFICANCE

The primary goals of postoperative care for exodontia patients have always been pain management and infection control. The most frequent postoperative consequences are pain and edema. Hence, ozone therapy can be used as an effective topical agent to manage postextraction pain and swelling in healthy patients without the need for excess medications. How to cite this article: Varghese LJ, Lahiri B, Penumatsa NV, et al. Effectiveness of Topical Ozone Gel Application in the Management of Postextraction Wound Healing: An In Vivo Study. J Contemp Dent Pract 2023;24(11):887-890.

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.

A Comprehensive Analysis of Clinical Crowns in Young of Han Nationality with Normal Occlusion Using Intraoral Scanning

Background

The measurement and analysis of clinical crowns play a crucial role in stomatology, anthropology, and studies of genetic and environmental variables in oral and maxillofacial development.

Purpose

The objective of the present study was to measure the parameters of clinical crowns of permanent dentition in youth of Han nationality using intraoral scanning and identify potential influencing factors.

Materials and Methods

A total of 100 subjects (50 males and 50 females) of Han nationality aged 18-24 with normal occlusion were selected. An intraoral scanner was used to obtain the digital dental impressions, and Materialise Magics 21 software was used to measure the mesiodistal diameter (MDD), buccolingual diameter (BLD), height, mesiodistal angle (MDA), and vestibulo-oral angle (VOA) of clinical crowns. The central height was calculated based on the height of clinical crowns. SPSS 27.0 software was used for statistical analysis. The two-independent-samplet-test was used to assess discrepancies in clinical crowns between males and females. The paired t-test was used to determine differences between antimetric pairs of clinical crowns within the same arch. The repeatability of intraoral scanning was tested using the paired t-test between two measurements at one-month intervals. The overall estimated effect was considered significant where P  <  0.05.

Results

The MDD, BLD, height, MDA, and VOA of clinical crowns in the youth of Han nationality were measured, and the central height was calculated. No significant difference was found in terms of MDA and VOA between genders and antimetric pairs within the same arch. Regarding the distance parameters, the MDD, BLD, and height of clinical crowns in males were significantly larger than those in females (MDD: U1, U3, U7, L2, L3, L6, and L7: P < 0.01; BLD: U1: P=0.02; U3-U7 and L1-L7: P < 0.01; height: U2: P=0.03; and U1, U3-U7, and L3-L7: P < 0.01). No significant difference was found in clinical crowns between antimetric pairs within the same arch. Intraoral scanning demonstrated good repeatability in the measurement of clinical crowns.

Conclusions

Apart from MDA and VOA, the parameters of clinical crowns in males were significantly larger than in females. Antimetric pairs of clinical crowns within the same arch demonstrated similar tooth dimensions. In future clinical practice and scientific research in the oral and maxillofacial region, a comprehensive design of sexual and ethnic characteristics should be considered.

Research efficacy of gaseous ozone therapy as an adjuvant to periodontal treatment on oxidative stress mediators in patients with type 2 diabetes: a randomized clinical trial

BACKGROUND

Chronic inflammation and cumulative oxidative stress have been theorized as two common pathways of the interconnection between periodontitis and diabetes. Improvement in oxidizing status has been demonstrated in periodontal patients with diabetes treated with proper non-surgical periodontal treatment. In addition to periodontal treatment, Gaseous ozone therapy has been reported to possess anti-inflammatory properties and the ability to stimulate the endogenous antioxidant defence mechanism. To date, the antioxidant effect of gaseous ozone, in addition with periodontal treatment in diabetic patients, has been examined in only one study. The aim of this study was to determine the efficacy of gaseous ozone therapy as an alternative approach to supporting non-surgical periodontal therapy (NSPT), aimed at improving antioxidant machinery and interfering with ROS production on plasma levels in diabetic individuals diagnosed with moderate or severe periodontitis.

METHODS

One hundred and eighty patients with periodontitis and type 2 diabetes mellitus were randomly assigned to receive non-surgical periodontal treatment (NSPT) plus gaseous ozone therapy (A) NSPT alone (B). Clinical and periodontal parameters -Bleeding on probing (BOP), Periodontal pocket depth (PPD), and Clinical attachment Level (CAL)- and plasma levels of oxidant-antioxidant (TOS- TAOS) levels, glutathione (GSH), and malondialdehyde (MDA) were recorded at baseline and at 3- (T1) and at 6-months (T2) after treatment.

RESULTS

Both treatments were efficacious in reducing clinical parameters. However, there were no significant differences regarding oxidative stress parameters in group A compared to group B.

CONCLUSIONS

In the present study, gaseous ozone therapy did not enhance the effect of periodontal treatment in reducing oxidative stress in plasma levels of periodontitis patients with type II diabetes.

TRIAL REGISTRATION

The study was registered with ISRCTN1728169 (23/07/2022).

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

INTRODUCTION

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

METHODS

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

RESULTS

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

CONCLUSIONS

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

In Vitro Evaluation of Tooth-Whitening Potential of Peroxide-Free OTC Dental Bleaching Agents

Purpose: To evaluate and compare the tooth-whitening potential of five over-the-counter (OTC), peroxide-free dental bleaching methods as well as an experimental tooth-whitening solution containing 0.1% hydrogen peroxide complexed with doping agents with a gold standard (positive control) containing 16% carbamide peroxide. Material and Methods: Eighty permanent bovine incisor teeth were randomly allocated to eight different groups. Two teeth from each group were immerged into five staining solutions represented by coffee, tea, red wine, and curry mixed in warm oil or distilled water (control group) and stored at 37 °C for 28 days in an incubator. The teeth were then reallocated to the eight groups, resulting in ten samples per group, and each group was matched with a bleaching product. The bleaching procedures were executed following the manufacturer’s recommendations. The color of each sample was assessed over a white and black background using a quantitative numerical measurement approach with a calibrated spectrophotometer. Spectrophotometric measurements were performed after exposing the teeth to the bleaching agent for 60 min (T2), 100 min (T3), and 200 min (T4), and ΔE00 was calculated. Results: When analyzed over a white background, the mean ΔE00 values ranged from 2.14 (placebo) to 6.32 (Opalescence PF). When analyzed over a black background, the mean ΔE00 values ranged from 2.31 (placebo) to 5.78 (Opalescence PF). Statistically significant ΔE00 color changes over time for the eight groups and five staining solutions at T1 and T4 were assessed for both backgrounds using repeated ANOVA followed by Fisher’s LSD post hoc test (p-value < 0.01). Conclusions: All tested over-the-counter whitening kits except one exhibited positive color variation. However, the individual performance differed vastly from one brand to the other, and the overall performance was less effective compared to the conventional carbamide-peroxide-based positive control.

Bleaching Effect of Ozonized Substances on Resin Composite: A New Potentiality for Ozone Therapy in Dentistry

Composite resins are commonly used in dentistry for direct restorations. The color stability of these materials still represents a major concern for both the clinician and the patient. In recent years, ozone therapy has been extensively used in dentistry to manage wounds healing, dental caries, oral lichen planus, gingivitis and periodontitis, halitosis, osteonecrosis of the jaw, post-surgical pain, plaque and biofilms, root canal treatment, dentin hypersensitivity, temporomandibular joint disorders, and teeth whitening. To date, several studies have evaluated the bleaching effect exerted by ozone on natural teeth, but no studies have been conducted to determine the effect on the color of composite resins. The aim of the present study is to determine whether ozonized oils/gels could determine a color change on composite resin. A total of 40 discs of an A3 shade restorative composite were divided into two groups, respectively exposed to a pigmentation treatment consisting of 10 applications of 10 min each of a 1% chlorhexidine-based gel (trial group) and to storage into physiological solution (control group). The samples of both groups were respectively subdivided into four subgroups which underwent four different protocols, three of which were based on the exposure to different ozonized products and the latter representing the control. A colorimetric analysis with the CIELAB method was conducted with the following timing: after 24 h of storage in physiological solution (before the experimental procedures) (T0), after the subdivision into groups A and B (corresponding to the pigmentation for samples of group A and storage in physiological solution for samples of group B) (T1), and after subdivision into subgroups 1–4 (corresponding to the application of the ozonized products vs. control) (T2). No statistically significant difference was found between the samples at T0. The 20 samples of group A, exposed to the colorant agent, underwent a color change from T0 to T1, whereas the 20 samples exposed to the physiologic solution did not undergo any significant color change. A positive but moderate influence was assessed for E and L values, whereas no significant change occurred for A and B values. Therefore, dental ozonized oils/gels could be valuable in restorative dentistry as bleaching agents of resin composites exposed to discoloration, an alternative to the traditional hydrogen peroxide and carbamide peroxide, but further studies are required to confirm these findings.

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

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

Topical-Ozonized Olive Oil - A Boon for Post-Extraction Cases: A Randomized Controlled Trial

Background Post-surgical therapy in exodontia patients has historically been largely centered on pain and infection prevention. Healing of the extraction wound has rarely received any importance during regular dental extractions, despite being an inherent element of the process of tooth extraction itself. This study aimed to analyze the analgesic and antibacterial efficacy of topical-ozonized olive oil compared to regular drugs administered post-operatively to patients who have undergone tooth extraction as well as evaluate the healing effects of the former on the extraction site. Methodology A total of 200 patients in need of exodontia were randomly divided into two groups, with group A (case group) receiving ozonized olive oil as a topical application for three days and group B (control group) receiving standard post-operative treatment (antibiotics and analgesics). On day five, patients in both groups were assessed for wound healing using the Landry, Turnbull, and Howley Index and for pain using the visual analog scale (VAS). Results On days two and three, the P-value for differences in pain (VAS score) between the two groups was 0.409, but on day five, it was 0.180. According to the Landry, Turnbull, and Howley index, the P-value for differences in wound healing between the groups on day five was 0.025. When comparing the two groups, there was no discernible difference in the amount of discomfort perceived after surgery. While both groups saw improvement in wound healing and pain, the case group coped better than the control group in terms of wound healing. Conclusions This study demonstrated that ozonized olive oil may be used as a safe and effective alternative to conventional painkillers and antibiotics and can speed up wound healing after exodontia.

Evaluation of the Sensitivity of Selected Candida Strains to Ozonated Water-An In Vitro Study

(1) Background and Objectives: Oral candidiasis has increased significantly in recent years. Increasingly, we encounter treatment difficulties related to drug resistance. Therefore, it is necessary to search for other therapies such as ozone therapy, which has antimicrobial activity. The aim of this study was to determine the sensitivity of selected Candida strains to ozonated water based on concentration and contact time (2) Methods: The sensitivity of Candida strains to ozonated water with a concentration of 5 µg/mL, 30 µg/mL, and 50 µg/mL was assessed using Mosmann's Tetrazolium Toxicity (MTT) assay. Statistical differences were assessed by the analysis of variance (ANOVA) and the Newman-Keuls post-hoc test. A p-value of ≤0.05 was considered to indicate a statistically significant difference. (3) Results: In all the strains and research trials, the number of viable cells was reduced by ozonated water. The reduction depended on the exposure time and concentration of ozonated water. The highest percentage reduction (34.98%) for the tested samples was obtained for the C. albicans strain after 120 s of exposure at the highest concentration-50 µg/mL. (4) Conclusions: The selected strains of Candida spp. were sensitive to ozonated water at all tested concentrations (5 µg/mL, 30 µg/mL, and 50 µg/mL). The sensitivity of strains to ozonated water increased with concentration and application time. Moreover, the sensitivity of Candida strains to ozonated water is comparable to that of 0.2% chlorhexidine gluconate.

The preventive care of medication-related osteonecrosis of the jaw (MRONJ): a position paper by Italian experts for dental hygienists

PURPOSE

The prevention and early diagnosis of medication-related osteonecrosis of the jaw (MRONJ) is fundamental to reducing the incidence and progression of MRONJ. Many in the field believe that dental hygienists should play an integral role in primary and secondary MRONJ prevention. However, to date, very few publications in the literature have proposed standardised MRONJ protocols, which are dedicated to dental hygienists. The aim of this study was to provide guidance to the health care providers managing MRONJ.

METHODS

The expert opinion in this study was developed by dental hygienists from the main Italian technical-scientific associations (Italian Dental Hygienists Association, AIDI and National Union of Dental Hygienists, UNID) and authors of the latest Italian recommendations regarding MRONJ from the field of dentistry and maxillofacial surgery.

RESULTS

The oral care protocol outlined in this position paper is focused on the role of dental hygienist in patients at risk or affected by MRONJ, and it regards 3 main issues: primary prevention, secondary prevention and supporting the treatment of MRONJ. Each issue contains easy-to-apply indications and procedures, as described by the authors, regarding the role of the dental hygienist.

CONCLUSION

Referring to the main issues under consideration (primary prevention, secondary prevention and the treatment of MRONJ), a clinical examination of periodontal tissue is critical in preventing MRONJ. It is the opinion of the authors of this study that the application of a periodontal screening score is fundamental in defining personalised strategies for patients at risk of MRONJ. By means of these basic procedures, a protocol for assisting the health care provider and the presentation of a practical approach for patients at risk or affected by MRONJ are described in this study.

Ozone Therapy for Dermatological Conditions: A Systematic Review

BACKGROUND

Known in the past for its toxic aspect as the main urban pollutant, in the last few decades, ozone has been gaining greater visibility for its possible antimicrobial, antiviral, and antioxidant effects when used in human dermatological pathologies. Despite the reports of clinical benefits, the standard dosage for clinical efficacy and safety are yet not clear, nor are its means of application and its true acting mechanism.

OBJECTIVE

We conducted a review to determine the efficacy and safety of ozone therapy for a variety of dermatological conditions.

METHODS

We considered clinical trials (both randomized and non-randomized) published between December 2020 and March 2021 as long as they provided some PICO information, i.e., population (P), intervention (I), and study design. The skin dermatological conditions researched were: acne, dermatitis, psoriasis, systemic sclerosis, herpes, aging, ulcers, and skin scarring.

RESULTS

A total of 326 articles were identified and 150 remained after duplicates were removed. After titles, abstracts and full articles were read, 17 articles were included in the systematic review (with 643 patients).

CONCLUSION

Ozone therapy seems promising for some dermatological conditions; however, the articles included in this review had methodological limitations and did not sufficiently demonstrate sound evidence for safe therapy. Therefore, more studies with better methodological standards and longer-term assessments of side effects should be conducted to achieve better standards and safety in ozone therapy for dermatological conditions.

Potential therapeutic effect of oxygen-ozone in controlling of COVID-19 disease

Atmospheric ozone is produced when nitrogen oxides react with volatile organic compounds. Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) genome contains a unique N-terminal fragment in the Spike protein, which allows it to bind to air pollutants in the environment. 'Our approach in this review is to study ozone and its effect on the SARS-CoV-2 virus and patients with coronavirus disease 2019 (COVID-19). Article data were collected from PubMed, Scopus, and Google Scholar databases. Ozone therapy has antiviral properties, improves blood flow, facilitates the transfer of oxygen in hypoxemic tissues, and reduces blood coagulation phenomena in COVID-19 patients. Ozone has immunomodulatory effects by modulating cytokines (reduction of interleukin-1, interleukin-6, tumor necrosis factor-α, and interleukin-10), induction of interferon-γ, anti-inflammatory properties by modulating NOD-, LRR- and pyrin domain-containing protein 3, inhibition of cytokine storm (blocking nuclear factor-κB and stimulating nuclear factor erythroid 2-related factor 2 pathway), stimulates cellular/humoral immunity/phagocytic function and blocks angiotensin-converting enzyme 2. In direct oxygen-ozone injection, oxygen reacts with several biological molecules such as thiol groups in albumin to form ozonoids. Intravenous injection of ozonated saline significantly increases the length of time a person can remain hypoxic. The rectal ozone protocol is rectal ozone insufflation, resulting in clinical improvement in oxygen saturation and biochemical improvement (fibrinogen, D-dimer, urea, ferritin, LDH, interleukin-6, and C-reactive protein). In general, many studies have shown the positive effect of ozone therapy as a complementary therapy in the recovery of COVID-19 patients. All the findings indicate that systemic ozone therapy is nontoxic and has no side effects in these patients.

Ozone Therapy for Early Childhood Caries (ECC) Treatment: An In Vivo Prospective Study

The present study aimed to evaluate the effectiveness of ozone therapy in (1) increasing the compactness of decayed dentin (main aim), (2) reducing dentin hypersensitivity, (3) decreasing the salivary bacterial count, and (4) improving the quality of life in ECC-affected children during a 3-month follow-up. A total of 20 subjects uncooperative with conventional restorative treatment were treated with a 60 s ozone application/week (OzoneDTA®) for 4 weeks. Patients were evaluated at T0 = baseline; T1 = after ozone cycle and T2, T3, T4 = 1, 2, 3-month follow-up, respectively. Dentin compactness was evaluated according to the Affected Dentine Scale (ADS) proposed by the authors; dentin hypersensitivity was recorded with the Wong–Baker Faces Pain Rating Scale (WBFPRS); salivary bacteria were measured with the Saliva Check Mutans Test and quality of life with the Early Childhood Oral Health Impact Scale (ECOHIS). ADS values and salivary bacteria count results were analyzed using non-parametric tests. Statistically significant differences were detected for both parameters between T0 and T1 (p < 0.01). At T1, dentin hypersensitivity was resolved and quality of life improved. Ozone therapy is a simple and painless approach, which might be useful for controlling caries’ progression in uncooperative children until appropriate cooperation is achieved.

Ozone treatment alleviates brain injury in cerebral ischemic rats by inhibiting the NF-κB signaling pathway and autophagy

Stroke is the most frequent cause of disability in developed countries. A common phenomenon of stroke, cerebral ischemia, is threatening many lives worldwide. In addition, ozone treatment was previously reported to exert functions in relieving brain injury. In the current study, the therapeutic effects of ozone on cerebral ischemia are investigated. A rat model of middle cerebral artery occlusion (MCAO) was established. The brain water content was calculated by weighing brain tissues, and the 2, 3, 5-triphenyltetrazolium chloride staining was performed to measure brain infarction volume in rats. A colorimetric assay was conducted to examine expression levels of malondialdehyde, superoxide dismutase, catalase, and glutathione in the rat hippocampus. Reverse transcription quantitative polymerase-chain reaction and Western blot analyses were employed to evaluate expression levels of Beclin1, LC3B, p62, and critical factors implicated in the NF-κB signaling pathway. We found that ozone significantly improved the survival rate of MCAO model rats, reduced the cerebral water content, and decreased the neurological scores of ischemic rats. Ozone markedly reduced cerebral ischemia-induced infarction in ischemic rats. Ozone decreased MDA levels and increased SOD, catalase, and GSH levels in the hippocampus of rats. Ozone significantly inhibited autophagy by decreasing Beclin1 and LC3B expression and increasing p62 expression. The ozone inactivated the NF-κB signaling pathway by decreasing the protein levels of TLR4, p-IKKβ, p-IKBα, and p-p65. We conclude that ozone treatment alleviates the brain injury in ischemic rats by suppressing autophagy and inactivating the NF-κB signaling pathway.

Ozone and microstructural morphological changes of tooth enamel

The paper aims to study the impact of ozone (O3) treatment on the microstructural changes of the tooth enamel after the treatment at different time intervals. The ozonation was performed with gaseous O3 produced by HealOzone X4, the demineralization level was measured with the DiagnoDent Pen 2190 device, and the microstructure changes of enamel surface were observed using scanning electron microscopy (SEM) analysis. The results showed the exposure to O3 for 40-50 seconds enhanced enamel micro-hardness and ensures a rate of remineralization between 96.82-97.38%. In conclusion, in search of new minimally invasive solutions in the treatment of caries and to offer antimicrobial support of the oral cavity, the use of O3 as an alternative therapy to classical solutions may be a viable solution in dentistry.

Effectiveness and Safety of Ozone Therapy for Dermatological Disorders: A Literature Review of Clinical Trials

Ozone is a strong oxidizing agent, capable of promoting therapeutic effects such as antimicrobial, anti inflammatory, antioxidant and healing activities, with low probability of toxicity when used in a specific dosage range. The aim of this study was to conduct a literature review to assess clinical trials available over the past 10 years regarding the effectiveness and safety of ozone therapy to treat dermatological disorders. The search for bibliographic material was carried out through PubMed, Cochrane Library and Google Scholar electronic databases. The inclusion criteria covered only controlled clinical trials published from 2011 to 2021 and written in English. The 18 selected clinical trials included 1279 patients (ranging from 12 to 400 patients per study), of which 1185 patients were adults and 94 were children. Ozone therapy was evaluated regarding the treatment of diabetic foot ulcers, digital ulcers, chronic venous leg ulcers, atopic dermatitis, skin burns, onychomycosis, tinea pedis, cutaneous leishmaniasis, balanitis xerotica obliterans and multiple common warts. Only three studies, addressing the treatment of cutaneous leishmaniasis, skin ulcers and skin burns, evidenced lack of effectiveness of ozone treatment. Mild adverse effects occurred in three clinical trials, whereas severe side effects occurred in only one clinical trial, regarding skin ulcers. Therefore, ozone therapy may be suggested as an alternative or complementary treatment in some types of dermatological conditions specially affecting refractory patients. Though, a greater number of high-quality clinical trials is needed to clearly establish the safety of ozone therapy in dermatological disorders.

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

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

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

Simple Summary

The search for new topical antimicrobial treatments represents an actual challenge both in orthopedics and in dentistry. As regards the latter, antiseptics represent an aid to the non-surgical treatment commonly employed to contrast periodontitis. This study aims to assess the efficacy of an ozone-based gel with respect to the more common chlorhexidine gels. Ten participants were treated by means of nonsurgical periodontal therapy, with, in addition, a chlorhexidine gel and an ozone one, both, respectively, used in half of the oral sites. Patients were visited at baseline, after one month, and after three months, and at each time point clinical indexes were assessed. This study revealed that the use of the ozonized gel in addition to the standard non-surgical therapy generally did not significantly differ if compared to the use of chlorhexidine. Based on this, ozone deserves consideration for its wide applicability in several clinical fields, especially considering the reduced number of shortcomings with respect to those generally related to chlorhexidine.

Abstract

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

Low Ozone Concentrations Affect the Structural and Functional Features of Jurkat T Cells

Autohemotherapy is the most used method to administer O2-O3 systemically. It consists in exposing a limited amount of blood to a gaseous O2-O3 and reinfusing it, thus activating a cascade of biochemical pathways involving plasma and blood cells that gives rise to antioxidant and anti-inflammatory responses. The therapeutic effects strictly depend on the O3 dose; it is therefore necessary to understand the relationship between the O3 concentration and the effects on blood cells involved in antioxidant and immune response. Here we performed a basic study on the effects of the low O3 concentrations used for autohemotherapy on the structural and functional features of the human T-lymphocyte-derived Jurkat cells. Ultrastructural, biomolecular, and bioanalytic techniques were used. Our findings showed that 10, 20, and 30 µg O3 concentrations were able to trigger Nrf2-induced antioxidant response and increase IL-2 secretion. However, viability and proliferation tests as well as ultrastructural observations revealed stress signs after treatment with 20 and 30 µg O3, thus designating 10 µg O3 as the optimal concentration in combining cell safety and efficient antioxidant and immune response in our in vitro system. These data offer novel evidence of the fine regulatory role played by the oxidative stress level in the hormetic response of T lymphocytes to O2-O3 administration.

Effect of Ozone on Corrosion Behavior of a Cobalt–Chromium Alloy Used in Removable Partial Denture Framework: An In Vitro Study

Aim:

The aim of this study was to evaluate the effect of the ozonated water on corrosion of a cobalt–chromium (Co-Cr)-based alloy, which is applied for the fabrication of metal frameworks of removable partial dentures.

Materials and Methods:

In this in vitro study, a total of 30 disk-shaped samples of a Co-Cr alloy were papered and randomly divided into two groups of 15 specimens. In group 1 (control), the specimens were stored in distilled water (DW), and in group 2, the specimens were stored in ozonated water. Around 90 immersions were performed, and the weight change of each specimen was determined. The ion release was analyzed using an inductively coupled plasma-optical emission spectrophotometer. The potentiodynamic polarization test was performed for each group to assess the corrosion resistance of the Co-Cr alloy. The statistical analysis was performed using SPSS version 22. Data were analyzed by independent samples’ t-test.

Results:

The results showed no significant difference between the weight changes of the two groups. The test using an inductively coupled plasma-optical emission spectrophotometer demonstrated no significant difference between the groups in Co and Cr ions release. In the potentiodynamic polarization test, both groups present similar corrosion behavior, and ozonated water has no deleterious effect on the corrosion resistance and passive range of the Co-Cr alloy compared to DW.

Conclusion:

As compared to DW, ozonated water has no significant deleterious effect on the corrosion resistance of the Co-Cr frameworks and can be used for cleaning the removable partial dentures.

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

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

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.

Effect of systemic ozone therapy as a biomodulator of tissue regeneration and inflammatory response in rats

Abstract Introduction Among the therapeutic effects of ozone therapy, improvement in cell metabolism and peripheral tissue oxygenation have been highlighted. Objective to evaluate the systemic effect of bio-oxidative therapy with ozone gas on wound healing. Material and method Tissue lesions with a circumference of 1.0 cm were induced in the skin on the back of 24 male Wistar rats. The animals were randomly divided into two groups: 1) Group C (control; n=12): with simulation of the application of ozone gas via the rectum and, 2) Group O3 (test; n=12): with application of ozone gas by means of rectal insufflation at a concentration of 50 µg/mL. The animals were euthanized at seven and 15 days, and samples were removed, fixed in formalin, and submitted to macroscopic, histological, and histometric analyses. Result The animals in the O3 group presented mixed inflammation at seven days, which translated into an absence of inflammation at 15 days. The C group exhibited acute inflammation on the 7th day, translating to chronic inflammation, which significantly increased from the 7th to the 15th day. The findings showed that the O3 group presented greater wound contraction (P<0.05) and a greater degree of neovascularization on the 7th day (P<0.05) when compared to group C. On the 15th day, both groups (O3 and C) showed complete re-epithelialization, however, the O3 group demonstrated complete muscle regeneration. Conclusion The systemic ozone therapy had a biomodulatory effect, reducing the characteristics of acute inflammation and increasing tissue repair and regeneration in rat skin.

Bio-Inspired Systems in Nonsurgical Periodontal Therapy to Reduce Contaminated Aerosol during COVID-19: A Comprehensive and Bibliometric Review

Background: On 30 January 2020, a public health emergency of international concern was declared as a result of the new COVID-19 disease, caused by the SARS-CoV-2 virus. This virus is transmitted by air and, therefore, clinical practices with the production of contaminant aerosols are highly at risk. The purpose of this review was to assess the effectiveness of bio-inspired systems, as adjuvants to nonsurgical periodontal therapy, in order to formulate bio-inspired protocols aimed at restoring optimal condition, reducing bacteremia and aerosols generation. Methods: A comprehensive and bibliometric review of articles published in English. Research of clinical trials (RCTs) were included with participants with chronic or aggressive periodontal disease, that have compared benefits for nonsurgical periodontal therapy (NSPT). Results: Seventy-four articles have been included. For probing depth (PPD) there was a statically significant improvement in laser, probiotic, chlorhexidine groups, such as gain in clinical attachment level (CAL). Bleeding on probing (BOP) reduction was statistically significant only for probiotic and chlorhexidine groups. There were changes in microbiological and immunological parameters. Conclusions: The use of bio-inspired systems in nonsurgical periodontal treatment may be useful in reducing risk of bacteremia and aerosol generation, improving clinical, microbiological and immunological parameters, of fundamental importance in a context of global pandemic, where the reduction of bacterial load in aerosols becomes a pivotal point of clinical practice, but other clinical trials are necessary to achieve statistical validity.

Comparison of efficacy of ozonated water, normal saline, and povidone-iodine after surgical removal of impacted mandibular third molars: A cross-sectional study

Background:

Surgical extraction of mandibular third molars is an important and one of the most frequently performed operative procedures in dentistry. There are a variety of postoperative complications that may follow this procedure. These include pain, trismus, infection, dry socket, or alveolar osteitis. Numerous techniques have been used for reducing these morbid conditions. These range from flap designs, suture placement, use of various irrigating solutions, etc.,

Aim:

The present study aimed to compare the effectiveness of three irrigating solutions: Ozonated water, normal saline, and povidone-iodine in reducing postoperative complications following surgical removal of impacted mandibular third molars.

Materials and Methods:

A total of 100 study participants formed the sample size of this study. Study subjects were categorized into three groups: Group I (third molar surgeries using ozonated water), Group II (third molar surgeries with normal saline irrigation), and Group III (third molar surgeries using povidone-iodine irrigation). Parameters studied postoperatively were alveolar osteitis (dry socket), pain, trismus, and infection after a week interval. All data obtained were entered in Microsoft Excel 2007 worksheets and Analysis of Variance (ANOVA) as a statistical tool was employed. A P value of < 0.01 was considered statistically significant.

Results:

It was found that ozonated water provided the best statistically proven results with comparison to normal saline and povidone-iodine in reducing the incidence of alveolar osteitis or dry socket and pain. No statistically significant difference was observed in the incidence of trismus and infection rate among three studied groups.

Conclusion:

Ozonated water is the best irrigating solution when compared to normal saline and povidone-iodine in terms of reduction in pain and dry socket after a 1-week duration.

Effectiveness and Safety of Ozone Therapy in Dental Caries Treatment: Systematic Review and Meta-analysis

OBJECTIVE

This systematic review and meta-analysis aimed to investigate the effectiveness and safety of ozone therapy for treating dental caries.

METHODS

We searched for randomized controlled trials (RCTs) in 8 databases, from inception to April 4, 2020 (MEDLINE, EMBASE, CENTRAL, LILACS, Bibliografia Brasileira de Odontologia, ClinicalTrials.gov, WHO, and OpenGrey). Primary outcome measures were antimicrobial effect and adverse events. We used the Cochrane risk of bias tool to evaluate methodological quality of included RCTs and GRADE approach to evaluate the certainty of the evidence. We used the Review Manager software to conduct meta-analyses.

RESULTS

We included 12 RCTs comparing ozone therapy with no ozone, chlorhexidine digluconate, fissure sealants (alone and added to ozone), and fluoride. Considering primary outcomes, ozone therapy showed (a) lower reduction in the bacterial number than chlorhexidine digluconate in children (mean difference [MD]: -5.65 [-9.79 to -1.51]), but no difference was observed in adults (MD: -0.10 [-1.07 to 0.88]); (b) higher reduction in the bacterial number than sealant (MD: 12.60 [3.86-21.34]), but no difference was observed after final excavation (MD: -0.00 [-0.01 to 0.01]). Regarding safety of ozone therapy, results from individual studies presented no adverse events during or after treatment. Most of these results are imprecise and should be interpreted with caution because of clinical and methodological concerns, small sample size, and wide confidence interval, precluding to determine the real effect direction.

CONCLUSION

Based on a very low certainty of evidence, there is not enough support from published RCTs to recommend the use of ozone for the treatment of dental caries. Well-conducted studies should be encouraged, measuring mainly the antimicrobial effects of ozone therapy at long term and following the recommendations of the CONSORT statement for the reporting of RCTs.

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

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

Use of the ozonation method in treating dentin caries in children’s permanent teeth

Relevance. Permanent teeth carious involvement starts from their eruption in children aged 5-6 years. Hard tissues mineralization in permanent teeth lasts long. Nowadays, efficacy of combined applying calcium containing drugs and the ozonation method while treating permanent teeth caries in children with incompleted processes of dental hard tissues mineralization has not been revealed.

Purpose. Increasing effectiveness of dentin caries treatment of children's permanent teeth with incompleted mineralization processes in dental hard tissues.

Materials and methods. There were carried out clinical and laboratory examinations and treatment of 41 children (aged 6-14). They had dentin caries in permanent teeth with incompleted mineralization processes in hard tissues .In 2 groups studied carious cavities were treated mechanically and medically and afterwards the dentin density measurement was made by the method of fluorecent analysis using DIAGNOdent apparatus. The mineralization degree of clinically intact dentin having been determined, in Group 1 Dycal paste and a hermetic temporary filling of glass ionomer cement were placed onto the floor of carious cavities. In Group 2 carious cavities were treated mechanically and medically and then ozonized during 30 seconds with Kavo - HealOzone apparatus followed by application of Dycal paste onto the floor of carious cavities and temporary filling with glass ionomer cement. Three months later, the temporary filling material and Dycal paste were removed out of the children's teeth in both groups and measuring mineralization degree of the clinically intact dentin was made again.

Results. Dentin mineralization increase in Group 1 showed 33,9% following delayed filling technique. In Group 2 the ozonation method promoted the increase by 54,9%.

Conclusions. Carious cavitiies ozonation before applying calcium containing material favours higher mineralization degree (by 21%).