Ozone in dentistry.
- 1. Presented by : Dr.Hiba Hussain Aouda 1
- 2. 1-Introduction. 2-Route of adminstration. 3-Mechanism of action . 4-Advantage of ozone in dentistry 5-Disadvantage of ozone in dentistry 6-Application of ozone in dentistry . 7-Contraindication for ozone uses . 8-Ozone safety 9-Ozone toxicity . 10-Conclusion . 2
- 3. Ozone is a blue gas, with strong odour and most important gas in the stratosphere. 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. 3
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- 5. A. Gaseous form Gaseous ozone could be administered topically either by an open system or by a sealing suction system to avoid inhalation and adverse effects. Most frequently used in restorative dentistry and endodontics. It is a noninvasive therapy for treatment of dental caries and may be used as a disinfectant before the placement of a direct restoration and also as therapy for hypomineralized teeth. 5
- 6. B. Ozonized water It has been shown to be efficacious against Gram-positive and Gram-negative oral microorganisms as well as bacteria in plaque biofilm. In comparison to other chemical cleaners, it appears to be less expensive. 6
- 7. C. Ozonized oil It is competitive antimicrobial agent due to wide accessibility of sunflower oil. It is found efficacious against Streptococci, Enterococci, Staphylococci, Pseudomonas, and especially Mycobacteria and is used for the cure of fungal infections 7
- 8. Ozone has been shown to be apowerful and reliable antimicrobial agent against bacteria , fungi, protozoa and viruses (kim et al,1999;Avita et al,2005). 8
- 9. Non invasive - minimal intervention technique. Induction of afriendly ecologic environment . Improves metabolism of infected tissues by mean of its oxidizing effect. 9 (Deepa and porja,2012)
- 10. The problem of maintaining the ideal tightness between the cap and the ozoned tooth . The device does not administer ozone when there is a risk of untightness. More time (may be 10 min) needed for aproper preparation of cap. 1 0 (Deepa and porja,2012)
- 11. 6-1-caries prevention: Dental caries is an irriversable microbial disease of the calcified tissue of teeth. 11 (leone&oppenheim,2001)
- 12. Ozone appears to be an integral part of non-invasive therapy of dental caries ,it could be used placing as adisinfectant prior to policy adirect restoration and as therapy for hypominaralised teeth (loncar et al,2009). Recarding incipient caries by oxidizing biomolcules with in bacteria ,ozone could eliminate the acidogenic bacteria within seconds leaving avirtually sterile surface and dentin structure that would remineralize(halting caries and clinically reverse lesion)(Azarpaz hood&Limeback,2008) 12 6-1-1-coronal caries prevention:
- 13. In one iraqi study, Habeeb(2008)found that 10sec exposure to ozonated water (4mg/L)has strong bacteriocidal activity aganist adherent mutant strep. On dentin surfaces of teeth that made is the best antimicrobial agent among the other tested antimicrobial agents(sodium hypochloride 5.25% and chlorohexidine 0.2 %) Ozone may arrest of caries , resulting in prevention or delaying the need for tooth restoration(Rick et al,2004). 1 3
- 14. Abu Nabaa 2002 Ozone treatment provoked the least anxiety comparing to traditional dentistry . Abu Nabaa 2003 Ozone treatment for 10 s significantly reminaralized leasion and could beproposed as an altrernative treatment for new pit and fissure lesion . Hath 2003 More caries reversal or reduced caries progresion was found in the ozone treated lesion after 3 months than in the an treated control lesion . 1 4 authors year finding
- 15. Ozone is the most effective in cases of shallow lesions since it shows enhanced ability to penetrate lesions which are about 1mm deep at the maximum. The ozone unit must also be used correctly; the ozone cap must be held directly against the caries lesion allowing the ozone to penetrate the decay and biofilm. 15
- 16. Where there is a cavitated 4mm deep root caries lesion adjacent to the gingival margin, simply using ozone treatment would probably not suffice. To manage this kind of a situation the outer caries must first be removed, leaving about 1 mm of caries over the cavity floor. Then the ozone treatment followed by routine restoration is indicated. Ozone should be considered an adjunct to existing treatment and preventive methods rather than an isolated treatment modality (Tiwari et al. 2017) 16
- 17. Ozone could be used as disinfectant prior to adirect restoration (Dahnhardt et al.,2006). Ozone gas has a strong bactericidal effect on microorganism in dentinal tubule of deep cavities,which could result in increasing success of restoraion(geliberti et al.,2006) 1n iraqi Habeeb(2008)recorded that ozonated water 4mg/L can be used for cavity disinfection without interfering with adequate bonding to dentin on the contrary it enhance the dentin bonding strength . 1 7
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- 19. A high level of biocompatibility of aqueous ozone on periodontal cells has been found 2 minute irrigation of the avulsed teeth with no isotonic ozonized 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. 1 9
- 20. Ozone application for 40-60 sec. might alleviate almost instantly the pain tablet by the patients from hypersensitive teeth the applying reminiralizing agent and repeat if necessary,this approach will remove sensitivity for not just afew days or weeks as in the case for some surface application but for anumber of years. Its work by openning the tubular structure , so it remove the organics debris, which then allows deep miniral penetration into the tubules (Holomes and delay,2003). 20
- 21. o The aim of conventional root canal therapy is to provide a clean, shaped, root canal that facilitates the placement of an adequate root filling. 2 1
- 22. 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 22
- 23. Clinical trial regarding the theraputic application of ozone in periodontal therapy have recently been approved by the US food and Drug Administration. Ozonated oils are in conjunction with scaling and prophylaxis but do not considered as an alternative to routine professional oral hygiene care (Filippi,1997). 2 3
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- 25. Brilliant result were notified with the use of ozonised oils and gels in treatment of periodontal pocket. The gel is loaded into an optident 1.25 ml small syringe and with afine blue acid-etch tip, the gel is delivered into pocket with ease. 2 5
- 26. 26 For larger pocket, it recommended to repeat this at 7- days intervals , on average, it can be achieved complete resolution of an infected pocket in about 2 days for smaller and 3-4 and 7 days for larger deeper pocket. As there is stimulation of reparative cellular mechanism the appearance of tissue is pink and healthy(Filippi,1997).
- 27. It is chronic bad breath that may be caused due to several issues. Bacteria that forms volatile sulfur compounds (VSCs) such as hydrogen sulfide and methylmercaptan are the main causes of the oral malodor . Ozone has the capacity to clinicaly alleviate oral malodor via direct oxidative inactivation of VSCs and their aminoacid precurcers(Silwood et al,2001). 2 7
- 28. 6-8-1-post extraction surgery: 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 2 8
- 29. After thorough assessment : I. Remove the necrotic plug and debris from the extraction site. II. Irrigate with large amount of ozonized water. III. fill the alveoli with ozonated oil. IV. Antibiotic coverage is indicated. V. Instruct patient to apply ozonated oil 3-4 times aday until total healing. 2 9
- 30. Gaseous or aqueous form of ozone may be used in cases of peri-implantitis. The abutment is fully covered by silicone cap. The gingival borders around the implant should be properly sealed. Ozone gas infiltrations can also be used in this situation. During debridement and curettage, irrigation is done with ozonated water. On the treated areas, 3–4 times daily application of ozonized oil can also be advised. (Gupta & Deepa 2016) 3 0
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- 32. Crown & bridge hypersensitivity is common during the temporization phase in crown , inlay/onlays and veneers procedures. Many factors might contribute to this event,one of which is the presence of bacteria left inside the opened dentinal tubules during preparation. It is paraamount to remove the smear layer and disinfect the prepared teeth before temporization and before seating of the final restoration (Holmes and Daley,2003). 3 2
- 33. 3 3 Prior to final prosthesis cementation,clean the prepared teeth with air abrasion ,disinfect with ozone gas and then seat the prosthesis (Holmes,2002).
- 34. A common occurrence found in full dentures wearers is denture stomatitis, mainly due to candida albicans. Found that ozone reduce candida albicans from dentures by 90% after just a half hour , and by over 99% after 60 min. Of treatment. To disinfect dentures , full acontainer large enough to submerge denture with cold water for 30 min. With the denture in the water ( Nagayoshi ,et al. , 2004). 3 4
- 35. There are various ways to whiten teeth, whether it is with a home kit or at a dental office. In a test conducted that bleaching teeth with 38% hydrogen peroxide and ozone resulted in whiter teeth than bleaching teeth with only 38% hydrogen peroxide (Tessier et al. 2010). 3 5
- 36. The temporomandibular joint is a hinge that connects jaw to the temporal bone on skull. In certain cases, patients have TMJ dysfunction, where there may be pain or dysfunction of the mastication muscles and the joints. The ozone gas was injected into the superior joint space. Ozone therapy has been shown to be more effective than medication for treating TMJ- related pain. (Doğan. 2014). 36
- 37. Ozone is particularly well suited to the management of viral lesions. The pain and disfigurement of perioral herpetic infections is a good example. In short order, the practitioner can render the areas comfortable and significantly accelerate the healing process. Interestingly, around 25% of lesions treated with ozone do not appear to recur. Both gas and ozonated oils are well suited to managing viral infections. (Domb 2014) 3 7
- 38. Ozonated water can also be used as a cold disinfection solution for medical for cabients and dental instruments as well as for cabients countertop of disinfection (Nagayosh et al.,2004). 3 8
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- 40. DUWL (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 purification(Al horman et al,2001) the result is a clean , colorless tap water . 40
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- 42. 1) Pregnancy 2) Hyperthyroidism 3) Glucose-6-phosphate dehydrogenase deficiency 4) Severe anemia 5) Severe myasthenia 6) Active hemorrhage 7) Acute alcohol intoxication 8) Recently reported myocardial infarction 42
- 43. According to most authers, a(10sec.) application of ozone causes the destraction of 99% of bacteria, and a(20sec.) application even of 99.9%. (Holmes,2004). Ozone is not toxic when it is given in the amount of 0.05 ppm for 8 hours. During ozone therapy amaximum concentration of ozone in oral cavity amounts to 0.01 ppm. 4 3
- 44. Inhalation of ozone may be toxic to the pulmonary system and other organs. Therefore, long-term exposure to ozone may indicate some side effects such as 1) upper respiratory irritation 2) bronchoconstriction 3) rhinitis 4) cough 5) headache 6) vomiting. In ozone poisoning, the patient is brought to supine position and treated with vitamin E and N-acetyl-cysteine (Nogales,2008). 4 4
- 45. • Ozone therapy has a wide range of applications in almost every field of dentistry. Its unique properties include immunostimulant, analgesic , antimicrobial , bioenergetics and biosynthetic actions. • Its a traumatic, painless, non invasive nature and relative absence of discomfort increase patient’s acceptability and compliance thus making it an ideal treatment choice specially for pediatric patients. 4 5
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