OZONE THERAPY

Presented ByDr. M. Shiva Shanker

II Year Post Graduate Student ,Dept of Periodontics, Mamata Dental College.

contents

• Introduction• History• Chemistry• Ozone generators• Biological actions• Goals• Routes of administration• Ozone therapy in periodontics• Ozone toxicity• conclusion

Introduction • The word ozone is derived from the greek

“ozein” meaning odorant.• It is an unstable gas and it quickly gives up

nascent oxygen molecule to form oxygen gas.

• Periodontitis is a destructive inflammatory disease of the supporting tissues of the teeth and is caused either by specific microorganisms or by a group of specific microorganisms.

History • In 1785, Van Marum noticed that air near his

electrostatic machine acquired a characteristic odor when electric sparks were passed.

• In 1801, Cruickshank observed the same odor at the anode during electrolysis of water.

• In 1840, Schonbein named the substance “Ozein”.

• it was not until 1932 that ozone was seriously studied by the scientific community, when ozonated water was used as a disinfectant by Dr. E.A. Fisch, a Swiss dentist.

• Joachim Hänsler, a German physicist, joined another physician, Hans Wolff, to develop the first ozone generator for medical use.

Ozone Therapy: A New Paradigm in Periodontics, Rose Kanwaljeet Kaur, 2014

CHEMISTRY:• Ozone is a triatomic molecule, Its

molecular weight is 47, 98 g/mol.• Thermodynamically highly instable

compound.• Medical Ozone is made when medical

grade oxygen is electrically activated (using an Ozone Generator) to form ozone.

• Medical grade Ozone is a mixture of pure O2 and pure O3 in the ratio of 0.1% to 5% of O3 and 95%-99.5% of O2 Ozone Therapy – A New Approach in Periodontal Management, Benita P, Volume 13,

Issue 3 Ver. I. (Mar. 2014),

• The ozone concentration may vary between 1 and 100 μg/ml (0.05-5%).

• Ozone gas has a high oxidation potential and is 1.5 times greater than chloride when used as an antimicrobial agent against bacteria, viruses, fungi, and protozoa.

Ozone Therapy – A New Approach in Periodontal Management, Benita P, Volume 13, Issue 3 Ver. I. (Mar. 2014),

How am I produced???

• Thunderstorms• UV rays• Ozone generators

OZONE GENERATORS:

• The first ozone generator was developed by Werner Von Siemens in Germany in 1857.

• Ultraviolet system• Corona discharge system• Cold plasma system

Garg R.K.,Tandon S. 2009.Ozone: A new face of dentistry. The Internet Journal of Dental Science,7(2). DOI: 10.5580/c75

Appliances producing ozone for Dental use

• HealOzone by KaVo• OzonyTron by MYMED Gmb H.• Product photo (Prozone) by W&H.

Ozone: A Future in Periodontal Therapy, Dr. Chandni Adalja, Volume : 3, Issue : 3, March 2013

How I work???• “ Transient oxidative burst”.

Am I Allergic to you???

BIOLOGICAL ACTIONS• Anti –microbial action• Anti –inflammatory & analgesic action• Immune-stimulating action• Anti-hypoxic action• Bioenergetic and biosynthetic action

GOALS• Elimination of pathogens.• Restoration of proper oxygen metabolism.• Induction of a friendly ecologic

environment.• Increased circulation.• Immune activation.• Simulation of the humoral anti-oxidant

system.Mollica P, Harris R. Integrating oxygen/ ozone therapy into your practice. Available from site: www.absoluteozone.com/Ozone_Article_Dentistry_ref.htm

ROUTES OF ADMINISTRATION• Gaseous ozone• Ozonated water • Ozonized oil

Advantages • Disinfectant.• Anti-inflammatory.• Activation of intracellular metabolism of

oral mucosa and dental wounds.• Improvement of regional circulation.• Stimulation of regenerative processes.• Hemostasis in capillary bleedings.• Painless procedures.

DISADVANTAGES• Ozone toxicity if the level increases at

0.0007% per application.• Instability.• Not readily available

INDICATIONS• Chronic or recurrent infections in the oral

cavity.• Sterilization of cavities, root canals,

periodontal pockets, herpetic lesions.• Desensitization of extremely sensitive

tooth necks.• Pre-washing of surgical sites.• Plaque control.• Contamination control.

CONTRAINDICATIONS:• Pregnancy – to avoid mutagenic risk.• Hyperthyroidism• Severe anemia• Thrombocytopenia• Cardiovascular instability• Patients on ACE inhibitors

OZONE THERAPY IN PERIODONTICS• Ozonated water (4 mg/l) was found

effective for killing gram-positive and gram-negative oral microorganisms and oral Candida albicans in pure culture as well as bacteria in plaque biofilm.

• Thanomsub et al. 2002 tested the effects of ozone treatment on cell growth and ultra-structural changes in bacteria (Escherichia coli, Salmonella sp., Staphylococcus aureus and Bacillus subtilis). It was discovered that ozone at 0.167 mg/min/l can be used to sterilize water, which is contaminated with up to 105 cfu/ml bacteria within 30 min. Destroying of bacterial cell membrane was observed, subsequently producing intercellular leakage and eventually causing cell lysis. Nevertheless, these ozone concentrations have no significant effect on the cell viability in bacterial cultures at higher concentrations of 106 and 107 cfu/ml.

• Ebensberger et al. in 2002 evaluated the effect of irrigation with ozonated water on the proliferation of cells in the periodontal ligament adhering to the root surfaces of 23 freshly extracted completely erupted third molars.

• They concluded that the 2 min irrigation of the avulsed teeth with non-isotonic ozonated water might lead not only to a mechanical cleansing, but also decontaminate the root surface, with no negative effect on periodontal cells remaining on the tooth surface.

• Nagayoshi et al. 2004 tested the efficacy of ozonated water on survival and permeability of oral micro-organisms.

• Gram negative bacteria, such as Porphyromonas endodontalis and Porphyromonas gingivalis were substantially more sensitive to ozonated water than gram positive oral streptococci and c. albicans in pure culture. Furthermore ozonated water had strong bactericidal activity against bacteria in plaque biofilm.

• Hems and Gulabivala, 2005 evaluated the potential of ozone as an anti-bacterial agent using Enterococcus faecalis as a test species.

• Ozone was used both gasiform (produced by Purezone device), and aqueous (optimal concentrations 0.68 mg/l).

• It was concluded that ozone in solutions was antibacterial against planctonic Enterococcus faecalis after 240 s treatment. However it was not effective against Enterococcus faecalis cells in a biofilm unless they were displaced into the surrounding medium by agitation. Gaseous ozone was not effective on the Enterococcus faecalis biofilm.

• Ramzy et al. in 2005 irrigated the periodontal pockets by ozonized water in 22 patients suffering from aggressive periodontitis. Periodontal pockets were irrigated with 150 ml of ozonized water over 5-10 min once weekly for a clinical 4 weeks study using a blunt tipped sterile plastic syringe. High significant improvement regarding pocket depth plaque index gingival index and bacterial count was recorded related to quadrants treated by scaling and rootplaning together with ozone application. They also reported significant reduction in bacterial count in sites treated with ozonized water.

• Huth et al. in 2006, in their study declared that the aqueous form of ozone, as a potential antiseptic agent, showed less cytotoxicity than gaseous ozone or established anti microbials (chlorhexidine digluconate [CHX]: 2%, 0.2%; sodium hypochlorite 5.25%, 2.25%; hydrogen peroxide-H2 O2 3%) under most conditions.

• Therefore, aqueous ozone fulfills optimal cell biological characteristics in terms of biocompatibility for oral application.

• Muller et al. in 2007 compared the influence of ozone gas with photodynamic therapy (PDT) and known antiseptic agents (2% chlorhexidine, 0.5 and 5% hypocholrate solutions) on a multispecies oral biofilm in vitro.

• Actinomyces naeslundii, Veillonella dispar, Fusobacterium nucleatum, Streptococcus sobrinus, Streptococcus oralis and c. albicans were studied.

• Gasiform ozone was produced by vacuum ozone delivery system Kavo Healozone. They concluded that the matrix-embedded microbial populations in biofilm are well protected towards antimicrobial agents. Only 5% hypochlorate solution was able to eliminate all bacteria effectively. Usage of gasiform ozone or PDT was not able to reduce bacteria in the biofilm.

• Kshitish and Laxman in 2010 conducted a randomized, double-blind, crossover split-mouth study on 16 patients suffering from generalized chronic periodontitis.

• They concluded that despite the substantivity of chlorhexidine, the single irrigation of ozone is quite effective to inactivate microorganisms.

• Fillippi. A observed the influence of ozonized water on the epithelial wound healing process in the oral cavity. It was found that ozonized water applied on daily basis can accelerate the healing rate in oral mucosa.

• Huth, et al. in 2011 compared the effectiveness of ozone with that of the established antiseptic CHX, against periodontal microorganisms. There were no significant differences in the effectiveness of aqueous ozone (20 μg ml [−1]) or gaseous ozone (≥4 g [−3]) compared with 2% CHX but they were more effective than 0.2% CHX. Therefore, high-concentrated gaseous and aqueous ozone merit further investigation as antiseptics in periodontitis therapy.

• Dodwad et al. in 2011 compared the effect of oral irrigation with ozonated water, 0.2% Chlorhexidine and 10% Povidone iodine in patients with chronic periodontitis. The study concluded that local ozone application can serve as potent atraumatic, antimicrobial agent to treat periodontal disease non-surgically both for home care and professional practice. It may also serve as good tool during supportive periodontal therapy.

• Sadatullah et al in 2012 analysed the effect of 0.1 ppm ozonated water on 24-hour supragingival plaque (SP) samples.

• Ozonated water at the 0.1 ppm concentration was effective in reducing the load of 24-hour plaque bacteria, but it did not eliminate them completely.

• Hayakumo et al in 2012 evaluated the clinical and microbiological effects of NBW3 irrigation as an adjunct to subgingival debridement for periodontal treatment.

• The present study suggests that subgingival irrigation with NBW3 may be a valuable adjunct to periodontal treatment.

• Yilmaz et al in 2013 evaluated the clinical and microbiological results of treatment with the Er:YAG laser and topical gaseous ozone application as adjuncts to initial periodontal therapy in chronic periodontitis (CP) patients.

• ozone has an antimicrobial effect equivalent to that of the Er:YAG laser.

• Punit vaibhav et al in 2013 in a case report A 42-years female patient was selected, who presented with a mild to moderately painful, exophytic, fibrous lesion on the upper anterior gingiva.

• Topical ozone therapy provides potential benefits for the treatment of exophytic gingival lesions.

• Shoukheba et al in 2014 evaluated the effect of subgingival application of ozonated olive oil gel as an adjunct to scaling and root planing (SRP) in aggressive periodontitis.

• The study concluded that (Oxactiv) gel could be a promising adjunct to SRP in the treatment of aggressive periodontitis.

• Habhasneh et al in 2014 aimed to determine the clinical and biological effects of the adjunctive use of ozone in nonsurgical periodontal treatment.

• Irrigation with ozonated water as an adjunctive therapy to SRP produces no statistically significant benefit compared with SRP plus distilled water irrigation.

• Kl Vandana et al in 2015 assessed the effect of chlorhexidine (CHX), povidone iodine (PI), and ozone (OZ) on the microorganisms in dental aerosols.

• The study concluded that CHX, PI and OZ showed similar effects in reducing aerobic and anaerobic CFU's at the chest mask and at 9 ft. OZ can be used as a preprocedural agent, considering its beneficial effects.

OZONE FOR TREATMENT OF PERIIMPLANTITIS

• El Hadary et al in 2011 evaluated the effect of ozonated oil under the influence of cyclosporine A in bone integration of dental implants.

• The administration of short term cyclosporine together with the topical application of ozonated oil may influence bone density.

• Hauser gerspach et al in 2012 investigated the antimicrobial efficacy of gaseous ozone on bacteria adhered to several surfaces of titanium and zirconium.

• Ozone treatment was carried out with an ozotop unit, 140ppm; 2L/min for 6-24 sec. p. gingivalis was eliminated in 24 seconds with ozone. S Sanguinis was more resistant and showed greater reduction in zirconium substrates.

• Mc Kenna et al in 2013 assessed the effect of subgingival ozone and/ or H2O2 on the development of peri implant Mucositis.

• ozone showed great potential for management of peri implant Mucositis.

OZONE TOXICITY• Ozone inhalation can be toxic to the

pulmonary system and other organs. • Known side-effects are upper respiratory

irritation, rhinitis, cough, headache, occasional nausea, vomiting, shortness of breath, blood vessel swelling, poor circulation, heart problems and epiphora.

OZONE INTOXIFICATION• Patient must be placed in supine position• Inhale humid oxygen• Ascorbic acid• Vitamin E• Acetylcystein

CONCLUSION• Ozone therapy allows a new vision, which complies

with needs and demands of the public for non-invasive, effective periodontal care and it is truly a paradigm shift in dental practice.

• Treating patients with ozone cuts off treatment time, eliminates bacterial count more precisely and moreover, it is completely painless resulting increased acceptability and compliance of the patient.

• Further research in ozone would bring a revolution in periodontal practice in near future.

References:• Clinical and microbiological effects of ozone nano-bubble water

irrigation as an adjunct to mechanical subgingival debridement in periodontitis patients in a randomized controlled trial, Sae Hayakumo, Clinical Oral Investigations March 2013, Volume 17, Issue 2, pp 379-388.

• Effect of chlorhexidine, povidone iodine, and ozone on microorganisms in dental aerosols: Randomized double-blind clinical trial, Ravleen Kaur, Year : 2014,Volume : 25,Issue : 2, Page : 160-165.

• Ozone Therapy : A New Revolution In Periodontics, Dr. Pradeep Chitnis, IJRD, May, 2013 Vol 2 Issue 5.

• The antimicrobial effect of 0.1 ppm ozonated water on 24-hour plaque microorganisms in situ, syed sadatullah, Braz. oral res. vol.26 no.2 São Paulo Mar./Apr. 2012

• Ozone and its use in periodontal treatment, open journal of stomatology, 2013,3, 197-202.

• Ozone in periodontics, natural remedy in dentistry, journal of dental herald, 2014.

• Current concepts of oxygen ozone therapy for dentistry, john a rotchfield.• Ozone therapy: a new paradigm in periodontis, journal of advanced

medical and dental sciences research, 2014.• Ozone in dentistry: microbiological effects of gas action depending on the

method and the time of application on using the ozonytron device, experimental study, katarzyna, annals academiae mcdial, 2011.

• The effect of subgingival ozone and or H2O2 on the development of periimplant mucositis: a double blind randomized controlled trial, danial f Mc Kenna, the inernational journal of oral and maxillofacial implants.