14

OZONE THERAPY

IN DENTISTRY

INTRODUCTION:

Definition
ozone is a blue gas, with strong odour and most important gas in the stratosphere due to its ability to filter UV rays which is critical for maintenance of biological balance in the biosphere.
In nature, ozone is formed by combination of oxygen in the air under the influence of factors such as UV radiation (from the sun), electrical discharges(lightening) , water falls & ocean waves crashing onto rocks.
ozone in stratosphere has a bad role in both the thermal structure of the stratosphere as well as the ecological framework for life on the Earth’s surface

Exposure to ozone occurs through its production by:

• office photocopying equipment,
• electric arc welding,
• mercury vapour lamps,
• laser printers,
• X-ray generators
• high voltage electrical equipment etc.

Ozone therapy was used extensively to treat:

• infections,
• battle wounds
• cancer up to 1950’s. But later the advent of chlorine water sterilization which is more economical redused the use of ozone .

However research is showing that this ‘old’ technology has a very important role to play in medical and dental treatment especially with the development of multiple resistant microorganisms to antimicrobials.

Medical grade ozone is made from pure medical oxygen because oxygen concentration in the atmospheric air is variable.

O3 is a powerful oxidant capable of:

• interacting as metabolic modulator
• anti-microbial agent.
• Increase blood circulation & immune response
• Ozone ( O3 ) is a Triatomic molucle.
• 10 times more soluble in water than oxygen
• More rapid healing responce





Ozone ( O3 molecular weight of 47.98 g/mol). also known as triatomic oxygen and trioxygen is a naturally occurring compound consisting of three oxygen atoms.

Ozone, a naturally found gas in the upper atmosphere filters potentially damaging ultraviolet light ( UV-light )from reaching the Earth’s surface.

Ozone therapy was accepted as an alternative medicine in the USA from 1880 and has been used for over 130 years in twenty countries throughout the world.







Fisch was the first dentist to use ozone in his practice in the 1930s. He used ozonated water during dental surgeries to aid in disinfection and wound healing.

Today ozone therapy is used extensively in Europe in both dentistry and medicine.

Ozone therapy can be defined as a versatile bio-oxidative therapy in which oxygen/ozone is administered via gas or dissolved in water or oil base to obtain therapeutic benefits.

Types of ozone

• Ozone gas
• Ozonated water
• Ozonated olive oil
These can be used as a single or in combination

MECHANISM OF ACTION:

• Actions of ozone:
• anti-microbial,
• anti-inflammatory,
• analgesic,
• immune stimulating,
• anti –hypoxic (rise of O2 in tissues )
• Detoxicating ( prevent toxication )
• bio-energetic and biosynthetic (activation of the metabolism of carbohydrates, proteins & lipids) actions.

• Anti–microbial action:

• oxidant action on cells by damaging its cytoplasmic membrane due to ozonolysis of dual bonds. It does not damage healthy human body cells because they have superoxide ,catalase, hydrolase and antioxidant nutrients like vitamin C &E which inhibit the uncontrolled activity of free radicals and thus all healthy cells are protected.
• Only unhealthy cells such as cancer cells which have lost this protective mechanism and organisms such as bacteria, viruses, fungi, parasites which are devoid of these antioxidants are destroyed.


• Anti –inflammatory & analgesic action:
• Ozone helps in the synthesis of biologically active substances such as prostaglandins which is beneficial in reducing inflammation and pain.
• Immune-stimulating action:
• The electromagnetic action of ozone stimulates and modulates immune system particularly lymphocytes .the application of medical ozone is extremely useful for immune activation of patients especially with a low immune status.

• Anti-hypoxic action:

• Ozone brings about the rise of O2 in tissues and improves transportation of oxygen in blood. Ozone acts as a super-oxygenator, bringing oxygen to tissues, assisting body in its natural healing process.
• Bioenergetic and biosynthetic action:
• Ozone activates mechanisms of protein synthesis, increases amount of ribosomes and mitochondria in cells, elevating functional activity and regeneration potential of tissues and organs.

• DENTAL OZONE GENERATORS; HEAL OZONE:

• The ozone unit for dental use was initially developed by CurOzone Inc. (Canada) and subsequently manufactured under license and distributed by KaVo Dental GmbH and Co. (Germany) under the name “HealOzone”.

• HEALOZONE PROCEDURE:

• The HealOzone procedure consists of a package which includes:
• A. The application of ozone gas, the use of remineralizing agents, a patient kit and information on oral hygiene.
• B. The HealOzone device comprises
• an air filter,
• vacuum pump,
• an ozone generator,
• a hand piece fitted with a sealing silicone cup and
• a flexible hose.
• The procedure usually takes between 20 and 120 second per tooth.


• Immediately after ozone application the tooth surface is treated with a remineralizing solution (reductant) containing:
• fluoride,
• calcium,
• zinc,
• phosphate.
• HealOzone application for the treatment of non cavitated lesions is usually repeated at 3 and 6 months.

• The OzoTop :

• The OzoTop is a free flow ozone delivery system using a corona discharge. It is a compact, easy to use tabletop unit. Due to the delivery system of the OzoTop, root canals and periodontal pockets can be penetrated easily. The system may be used in all cases where point of placement disinfection is needed, including periodontology, endodontology, restorative, implantology, apthous ulcers/herpes,dentures and impression materials.
• Ozone is applied at 6, 12, 18, 24 seconds, depending on which treatment is required.

• OZONE ADMINISTRATION:

• There are three basic forms of ozone application.
• ozone gas
• ozonated water and
• ozonated oil
• These forms of application are used singly or in combination to treat dental disease.
• Ozone gas has a half life of about 5-30 min
• Ozonated water has a life span of about 10hrs if the water is kept cold.
• Ozonated oil produces a stable product (ozonides) with a longevity exceeding 15 yrs.


• INDICATIONS:
• Arterial circulatory disorders
• Immunodeficiency and Immune disbalance ‑ Additive therapy in carcinoma patients diseases caused by viruses (e.g.,: Hepatitis)
• Inflammatory conditions
• Rheumatic diseases
• External ulcers and skin lesion
• External ulcers and skin lesions
• Dentistry.
• Ozone is also used in the pharmaceutical industry, food
• processing industry, fabrics and cosmetics.

• CLINICAL APPLICATION OF OZONE IN PEDIATRIC DENTISTRY:

• With all the evidence of different actions and lack of toxicity ozone is developed into a new noninvasive tool for the treatment of diseases in medicine and dentistry.
• INFECTON LESIONS: Soft tissue lesions like:
• Herpes,
• Aphthae,
• Removable denture ulcers,
• Cuts,
• Cheilitis, Candidiasis, Cysts and Traumatic wounds can be treated with either Ozonated water or oils.
• The disinfectant and healing properties help in the healing of these lesions.


• Remineralization of Caries:
• In superficial root caries or early pit and fissure carious lesions, ozone alone may be sufficient to treat these lesions.
• However, in situations where severe breakdown of tooth structure has occurred, ozone may be used initially to promote remineralization and when this has occurred the cavity may be restored with a suitable restorative material.

• Restoration of Large Cavitations Along With Conventional Conservative Measures:

• The larger lesions are not those to be treated with ozone alone; most will require a combined approach of traditional therapy, as well as ozone.
• Where the lesion extends deep into the dentine, the action of ozone will take a longer time period of treatment, or may require several treatment periods over time.
• The basic protocol is the same;
• the soft debris is removed along with any unsupported enamel. If possible, denatured dentine is removed to the leathery layer.
• Ozone is applied from 40 seconds or longer. Some practitioners are using 2 to 3 minutes for large deep lesions that extend on x-ray almost to the pulp chamber.
• Then, the remineralizing wash is applied.

• Bleaching :

• In root canal treated teeth , crown discoloration is a major aesthetic problem, especially in anterior teeth. Conventional walking bleach requires much more time and results are not often satisfactory. Also, capping the tooth with ceramic crown in young permanent incisors is not indicated. An alternative option is placing the bleaching agent then the crown is irradiated with ozone for minimum of 3-4 minutes. This ozone treatment bleaches the tooth within minutes and gives the patient a happy and healthier-looking smile

• Endodontic Treatment :

• The aim of conventional root canal therapy is to provide a clean, shaped, root canal that facilitates the placement of an adequate root filling.
• There may be multiple canals in a single root in this situation, current procedures can be modified, to greatly improve the quality of treatment for patients.
• When irrigating with the usual irrigant solution, for example sodium hypochlorite, ozone can be applied to the hypochlorite solution in the root canals. This technique allows the root canal system to be thoroughly disinfected and possibly be sterilized.
• Also that ozone will penetrate through the apical foramen, and enter into the surrounding and supportive bone tissue. The effect of ozone on these tissues will be to encourage healing and regeneration.

• Ozonated water in decontamination of avulsed teeth before replantation:

• A high level of biocompatibility of aqueous ozone on periodontal cells has been found .Two-minute irrigation of the avulsed teeth with no isotonic ozonated water not only provides mechanical cleansing, but also decontaminate the root surface, with no negative effect on periodontal cells remaining on the tooth surface before replantation

• Extraction:

• Ozone was found to accelerate the healing of the wounds. After a tooth is extracted or any surgical procedure the area is irrigated and insufflated which promotes faster healing without complications

• Disinfectant:

• Ozonated water effective for killing gram-positive and gram-negative oral microorganisms and oral Candida albicans.
• Gaseous ozone can be clinically useful for disinfection of dentures

• INDICATIONS OF OZONE THERAPY IN DENTISTRY

• Ozone has therapeutic applications in various
• dental treatment modalities. Ozone therapy presents great advantages when used as an adjunct to conventional treatments.

• Ozone in the management of caries.

• Ozone, in gaseous or aqueous phase, has been
• shown to be a powerful and reliable Antimicrobial agent against bacteria, fungi, protozoa, and viruses.




• Ozone has a severely disruptive effect on cariogenic bacteria, resulting in elimination of acidogenic bacteria. The strongest naturally occurring acid, produced by acidogenic bacteria during cariogenesis is pyruvic acid. Ozone can decarboxylate this acid to acetic acid which enhance the remineralization of the carious lesion.

• Treatment with ozone gas significantly

• reduced caries progression,
• remineralized and
• arrested carious lesions in patients at high caries risk. It was also observed that ozone treatment being noninvasive
• provoked least state of anxiety compared to traditional dentistry.
• Non cavitated lesions were more likely to reverse than cavitated lesions.
• Initial studies have indicated that an application of ozone is capable of clinically reversing leathery root carious lesions.

• Ozone in Restorative dentistry:

• ozone gas can be applied before etching and the placement of sealant with no negative impact on sound enamel physical properties, including knoop surface microhardness or contact angle.





• The longer exposure to ozone gas has a strong bactericidal effect on microorganisms within the dentinal tubules of deep cavities, which could result in increasing the clinical success of restorations, with no negative impact on dentin and enamel shear bond strength of adhesive restoration.

Uses of ozone in operative dentistry

• Pits & fissures & proximal caries
• Hypersensetive teeth
• Crown, bridge & veneer
• Whitening of teeth
• Ozone therapy in endodontics
• Periodontal therapy
• After scaling
• TMJ treatment
• Post extraction
• Peri-implantitis
• Soft tissue lesiones
• Endodontic therapy


• Ozone therapy in endodontics :
• Ozone has great potential to be used as an antimicrobial in endodontics. Micro organisms are one of the cause in the failure of root canal therapy. Ozone is one of the most powerful antimicrobial agents with enormous advantages to reduce the number of micro organisms in the root canal.

• Ozone is effective when it is prescribed in sufficient concentration, used for an adequate time and delivered correctly into root canals after the traditional cleaning, shaping and irrigation has been completed. Studies have proved the potential use of ozone gas, ozonated water and ozonised oil in endodontic therapy.

• CONTRAINDICATION:

• Pregnancy
• Glucose‑6‑phosphate‑dehydrogenase deficiency
• Hyperthyroidism
• Severe anemia
• Severe myasthenia
• Acute alcohol intoxication
• Recent myocardial infarction
• Hemorrhage from any organ
• Ozone allergy.

• CONCLUSION:

• Ozone therapy allows a new vision, which complies with needs and demands of the public for noninvasive, effective dental care and it is truly a paradigm shift in dental practice.
• Ozone therapy has opened new ways in treatment for dental patients of all ages and applicable to a wide range of conditions of intra oral hard and soft tissues.
• It is especially suitable to the younger patients who are often scared of “drilling” and find conventional treatment unacceptable.

• The ozone therapy has been more beneficial than present conventional therapeutic modalities that follow a minimally invasive and conservative application to dental treatment.
• Treating patients with ozone therapy reduces the treatment time with a great deal of difference, and it eliminates the bacterial count more precisely.
• The treatment is completely painless and increases the patients’ acceptability and compliance with minimal adverse effect