Ozone therapy in dentistry المرحلة الخامسة
د.خوله محمد صالحOzone is a gas composed of three atoms of Oxygen and present naturally in the upper layer of atmosphere in abundance. It has got the capacity to absorb the harmful ultra-violet rays present in the light spectrum from the Sun. Thus, ozone filters the light spectrum high up in the atmosphere and protects the living creatures from the ultra-violet rays.
History of Ozone
Christian Friedrich Schönbein, a German chemist is considered to be the father of ozone therapy (1840). When he passed an electrical discharge through water, a strange smell was produced, which he called ozone, from the Greek word ozein (odor).
It is an amazing thought that the use of ozone in dentistry became popular after the Second World War, despite the low level of technological comfort offered by the ozone-producing devices.
Edward Fisch was the first dentist to use ozone in 1950. He used ozone to treat Austrian surgeon Ernst Payr who then became an ozone supporter and began a line of research dedicated to its use in healthcare. At the time, ozone therapy was difficult and limited due to the lack of ozone-resistant materials, such as Nylon, Dacron, and Teflon, until 1950 when ozone-resistant materials were manufacture.
At that time Joachim Hänsler, a German physicist and physician, joined another German physician, Hans Wolff, to develop the first ozone generator for medical use. Their design continues to be the basis for modern equipment. Medical grade ozone is a mixture of pure oxygen and pure ozone in the ratio of 0.05% to 5% of O3 and 95% to 99.95% of O2. Due to the instability of the O3 molecule, medical grade ozone must be prepared immediately before use. Within less than an hour after preparation only half of the mixture is still ozone while the other half is transformed into oxygen. As a result, it is impossible to store ozone over long periods of time. In order to control the decomposition of O3 into oxygen it can be associated with a vehicle with aqueous properties to promote the conversion more quickly or with a vehicle with more viscous properties to retard the conversion
In the first case, Sandhaus used professional cleaning methods, irrigation with ozone water and a series of ozone gas applications. In the second case, he performed an incision in order to drain the empyema and rinsed the infected area of the submucosa with ozone water and ozone gas insufflations. These measures were repeated every day for a week. In both cases, infectious complications were successfully combated. Sandhaus considered the application of ozone to be better than chemotherapy.
This gas is a highly effective surface disinfectant for instruments, implants and prostheses. Due to the spontaneous and catalyzed breakdown of the molecule, it is suitable for use in the mouth during surgical interventions; the positive biophysical properties mean that it promotes wound healing and epithelization and reinforces the natural antiradical principles of cells (by means of enzyme induction).
Ozone therapy has been established as a safe and effective method for preventing and treating dental caries .Unlike conventional methods ,which are highly invasive , this novel treatment approach promotes caries reversal and the re mineralization of teeth without damaging their structure.
Ozone gas also demonstrably helps in the treatment of surface caries, promotes wound healing and epithelization and supports professional prophylaxis..
There are three different systems for generating ozone gas:
• Ultraviolet System: produces low concentrations of ozone, used in esthetics, steam bath, and for air purification.
• Cold Plasma System: used in air and water purification.
• Corona Discharge System: produces high concentrations of ozone. It is the most common system used in the medical/ dental field. It is easy to handle and it has a controlled ozone production rate.
Procedure;
The machine is composited of an ozone generator and a hand piece attached to the comfort with a multi-lumen tube. For treatment of carious lesions the hand piece has to be fixed to the surface of the teeth via a single-use sealing cup to deliver ozone .Around 20-40 seconds of ozone application have shown to be penetrate through carious dentin to eliminate any living bacteria.
Ozone gas can also support professional prophylaxis. In part 2 of this series, the application will be presented in a severe case of Parodontitismarginalis in the frontal region of the upper jaw, which it was possible to clinically significantly improve by repeated application of ozone gas (Prozone). Ozone gas also demonstrably helps in the treatment of surface caries (fissure, occlusal and root caries). Initial results indicate that ozone may also be used in the treatment of per implantitis and endodontal infections. It is more biocompatible and less cytotoxic than sodium hypochlorite.
Uses of ozone
The reliable microbiological and metabolic properties of ozone, in either the gaseous or aqueous phases make it a useful disinfectant with a wide range of activity .
Major industrial uses of ozone:
Disinfectant agent in drinking water and air
Equipment sterilization
Treating industrial wastes
Rapid drying of varnishes and printing inks
Disinfect agent of food in cold storage
Bactericide
Prevent the growth of yeast and mould in fruit storage
Removal of chlorine from nitric acid
Producing steroid hormones
Oxidation of phenols and cyanides
Ozone As a disinfectant
Ozone has long been used as a water disinfectant due to its reliable oxidation quality with regard to chemical, organic and biological layers. It is suitable for reducing bacterial contamination in dental water and in dialysis systems. If it is introduced at regular intervals, it can prevent the formation of bio films in tubes and hose systems.
The solubility of ozone in water (50 ml ozone in 100 ml water at 0 °C) is ten times greater than that of oxygen. The half-life of ozone ranges from 1 hour at 22 °C6 to approx. 3 hours at 4 °C, when double-distilled water is used as a solvent.
Indications of Ozone in dental problems.
Cavities develop as the environment below the surface of the tooth becomes acidic. Ozone not only kills the acid-making bacteria, it also neutralizes their acidic waste. This creates a new environment that is hostile to the bad strep's and lactobacilli that love the acid niche. A new environment allows healthier bacteria to replace the bad ones. If we just kill off the bacteria, they’re back in weeks. But if we get rid of their acid niche, they are gone for two to three months. Ozone treatments at this interval just might keep teeth decay-free indefinite.
Very recently, in dentistry, ozone has got its role in various dental treatment modalities. Interest in ozone use in dentistry is due to the infectious diseases associated with the oral cavity. Ozone therapy presents great advantages when used as a support for conventional treatments, for example, to dental caries, periodontal procedures, and endodontic treatment;
Prophylaxis and prevention of caries
Re mineralization of pit and fissure caries
Re mineralization of root and smooth surface caries
Restoration of open cavitations along with conventional conservative measures
Bleaching of discolored root canal treated teeth
Endodontic treatment
Desensitization of extremely sensitive tooth necks
Soft tissue pathos's.
Caries prevention and re mineralization
Ozone can be used to kill bacteria present in carious lesion, painlessly and even without anesthetic. Ozone is applied to the carious lesion in a controlled manner, safely killing bacteria that have caused caries, thus requiring minimal of physical intervention and just a few seconds. In cases of incipient caries, ozone can kill bacteria in the de mineralized part and this de mineralized tooth structure then, can be using a special re mineralization kit, containing Calcium, Fluorine, Phosphorus and Sodium, all in their ionic forms.
The new environment that occurs following the bio-chemical change in the lesion allows minerals to flow back into the tooth, hardening and reversing the effects of decay. Early cavities can heal. The minerals to assist this repair can come slowly from the saliva or much quicker from mineral-rich solutions soaked into the teeth following the ozone treatment. Research seems to indicate that once a tooth is re mineralized, it is very unlikely the decay will come back. Multiple ozone treatments over a period of months can improve chances even better.
Now we have to be realistic here. If your tooth has a big hole in it, ozone isn’t going to re grow that tooth structure. Not even the tooth fairy can do that! But if there is still structure remaining in the earlier phases of attack, that structure can harden.
To improve the chances of staying cavity-free, we can seal challenging grooves of the teeth with glass ionomer such as the fluoride-rich Fuji Triage.
Desensitization of sensitive root necks
Quick and prompt relief from root sensitivity has been documented after ozone spray for 60 seconds followed by mineral wash onto the exposed dentine in a repetitive manner. This desensitization of dentine lasts for longer period of time.
Endodontic treatment
Ozone oils can be used to sterile the root canal systems and to clear the canals of necrotic debris by virtue of ozone’s bactericidal and effervescent properties. Ozone oils are ozonated sunflower oil or olive oil or groundnut oil. This ozone oil irrigation is more quick and efficient in canal sterilization than that conventional irrigation by the sodium hypochlorite and sodium peroxide combination.
layer present over the expose root surface prevents the penetration of ionic Calcium and Fluorine deep into the dentinal tubules. Ozone removes this smear layer, opens up the dentinal tubules, broadens their diameter and then Calcium and Fluoride ions flow into the tubules easily, deeply and effectively to plug the dentinal tubules, preventing the fluid exchange through these tubules. Thus, ozone can effectively terminate the root sensitivity problem within seconds and also results last longer than those by conventional methods.
Soft tissue pathos's
Ozone has been reported to accelerate the healing of soft tissue conditions, i.e. aphthous ulcers, herpes labialis, ANUG and other gum infections. It also reduces the post-extraction healing time by forming a pseudo-membrane over the socket, so protecting it from any physical and mechanical insults.
Bleaching
In root canal treated teeth, crown discolouration is a major aesthetic problem, especially in anterior teeth. Conventional walking bleaching requires much more time and results are not oftenly satisfactory.
After removing the root canal filler material from the pulp chamber, the canal is sealed tight at the level of cementoenamel junction. Then, the chamber is cleansed with sodium peroxide solution to remove any debris, cement particles and the smear layer, leaving the dentinal tubules opened-up. Now, a bleaching paste or a cotton pellet moistened in bleaching solution is packed in the chamber and the orifice is sealed with the Glass-inomer cement. After placing the bleaching agent into the inner of the tooth, 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.
. Post-Extraction After final debridement of the socket, irrigate with copious amounts of ozonated water and then use gauze imbibed with ozonated water to compress the extraction site. Before retiring the patient, fill the socket with ozonized oil and cover it with gauze.
Post-Extraction Alveolitis After thorough assessment, remove the necrotic plug and debris from the extraction site, irrigate with large amounts of ozonated water then fill the alveoli with ozonized oil. Antibiotic coverage may be indicated. Instruct the patient to apply ozonized oil 3-4 times a day until total healing.
.Peri-Implantitis Peri-implantitis is very bother to both the dentist and the patient. After thorough assessment and if a decision is taken to salvage the case, different modes of therapy are used in order to save the implant from total loss. Laser and/or manual debridement along with antiseptic solutions and topical anti-microbial medicines are commonly performed with a varying degree of success. Ozone can play an important role and be used as gas or in aqueous form. Cut an appropriate length of PVC or silicone cap and cover fully the abutment. In case the crown is still present, it is advisable to remove it for proper sealing of the abutment and the gingival borders around the implant.
Instruments Cold Disinfection
Ozonated water can also be used as a cold disinfection solution for medical and dental instruments, as well as for cabinets countertop disinfection. Ozonated water can also be used as hands wash disinfectant solution, fiber optic tips, contact lenses, surgical loupes lenses, etc.
. Dental Unit Water Lines Disinfection - Office Tap Water Disinfection
Ozone use in city water disinfection and purification worldwide is recognized as the best city water treatment today. It becomes only logical to use ozone for the dental office tap water disinfection and decontamination.
The result is a clean, odorless, colorless tap water. Dental unit water lines are known to carry hard to remove biofilms inside them. Besides the bad odors coming out of these dirty water lines, the microbial biofilm may represent a source of infection to patients, especially who have a deficient immune system or the elderly. Many studies showed almost complete disintegration and elimination of dental unit water lines biofilms with ozonated water.
Ozonized Olive Oil Application
In many instances, the soft tissue lesions we frequently see can be managed with only the daily at home application of ozonized olive oil. These oils have a greater advantage over commonly used antiseptics and ointments due to their wide range of activities during all phases of the healing process. Supply the patient with enough ozonized oil in a disposable syringe and home use instructions.
. Crowns & Bridges - Veneers
A common occurrence we sometimes see during the temporization phase in crowns, inlays/onlays and veneers procedures is hypersensitivity. Many factors might contribute in this event, one of which is the presence of bacteria left inside the opened dentinal tubules during preparation. It is paramount to remove the smear layer and disinfect the prepared teeth before temporization and before seating of the final restoration.
The black stain that we see under the temporaries, mainly in the shrink-wrap veneers temporization technique is due to the presence of bacteria. The use of ozone gas to both disintegrate the smear layer and disinfect the prepared teeth is highly recommended.
The use of Air Abrasion before ozone is an advantage to completely remove microscopic debris and smear layer from the surface of the abutments and to leave a clean dentin for ozone disinfection.
Prior to final prosthesis cementation, clean the prepared teeth with Air Abrasion, disinfect with ozone gas and seat the prosthesis according to your preferred method.
Use ozone gas to disinfect the prosthesis. Ozonated water can also be used.
. Removable Dentures
A common occurrence found in full dentures wearers is denture stomatitis, mainly due to Candida albicans . Whether white patches or erythematous forms, ozone use, mainly ozonated water and oil, is highly efficient in this situation and also helps in the cleaning and disinfection of the dentures acrylic material.
Prepare ozonated water using Acquazone and soak the denture(s) after thorough cleaning and removal of hard deposits. Imbibe a 5x5 cm gauze with the prepared ozonated water and apply on the affected areas. Refresh the gauze with ozonated water frequently or replace with a new one.
Remove excess water from the dentures and apply few drops of ozonized oil on the inside of the denture(s) and seat firmly.
Supply the patient with enough ozonized oil in a disposable syringe and home use instructions. For dentures sores and ulcers, see Soft Tissue Lesions section.
Some practitioners even recommend intra or peri-infiltration of ozone gas in soft tissue carcinoma lesions. The most soft tissue lesions encountered are herpes, aphthae, removable denture ulcers, traumatic wounds .
Ozone therapy contra-indications
The following are contraindications for use of ozone therapy
Pregnancy
Glucose-6-phosphate-dehydrogenase deficiency (fauvism)
Hyperthyroidism
Severe anemia
Severe myasthenia
Active hemorrhage
moreover, it is completely painless, so increasing the patients’ acceptability and compliance. Ozone can now be incorporated in various other treatment modalities also, like bleaching of discolored teeth, root canal treatment, desensitization and treatment of some soft tissue infections. Ozone, definitely, seems to be a promising treatment modality for various dental problems, in future.