MODERATOR: DR PALLVI

PRESENTED BY :

DR. ISHANI SHARMA

OZONE in dentistry

CONTENT:

1. Introduction

2. History

3. Mechanism of action

4. Dental ozone generators

5. Ozone administration

6. Indication

7. Clinical application of ozone

8. Ozone toxicity

9. Cure for ozone toxicity

10.Contraindication

11.Conclusion

INTRODUCTION:

• OZONE is a blue gas, with strong odour and mostimportant gas in the stratosphere due to its ability to filterUV rays which is critical for maintenance of biologicalbalance in the biosphere.

• In nature, ozone is formed by combination ofoxygen in the air under the influence of factors suchas UV radiation (from the sun), electricaldischarges(lightening) and intense physical stresson water (such as water falls & ocean wavescrashing onto rocks).

• Ozone therapy was used extensively to treatinfections, battle wounds and in routine treatmentof cancer up to 1950’s. But later the advent ofchlorine water sterilization which is moreeconomical declined the use of ozone .

• Medical grade ozone is made from pure medical oxygenbecause oxygen concentration in the atmospheric air isvariable.

• O3 is a powerful oxidant capable of interacting asmetabolic & immune modulator as well as anti-microbialagent.

There are three different systems for generatingozone gas.

1. Ultra violet system: produces low concentrations ofozone, used in aesthetics & for air purification.

2. Cold plasma system: used in air and water purification.

3. Corona discharge system: produces high concentrationsof ozone. It is the most common system used in themedical/dental field.

HISTORY:

• Christian Friedrich Schönbein (1840), a German Chemist,is regarded as the Father of ozone therapy. When hepassed an electrical discharge through water, a strangesmell was produced, which he called Ozone, derived fromthe Greek word ‘OZEIN’ which means odor.

• In 1857 Joachim Hänsler, a German physicist andphysician, along with German physician,developed the firstozone generator for medical use.

• In 1860,Monaco first used it in water treatment plants .

• Dr. C. Lender in 1870. He purified blood in test tubes byusing O3 . Later, O3 application gained as a popularity as atherapeutic procedure throughout Europe and America

• In 1881, it was used as a disinfectant in the treatment ofdiphtheria.

• In October 1893, Ousbaden, Holland became the first cityto utilize a water treatment plant using ozone.

• In World War I and II it was used to treat woundedsoldiers in the trenches .

• In early 20th century Food and Drug Act, revised its useand effect in the field of medicine.

• A German dentist, Dr. E.A. Fisch, in 1950, used ozonatedwater for dental procedures and pioneered its use inmedicine.

MECHANISM OF ACTION:

• There are several actions of ozone such as anti-microbial,anti-inflammatory, analgesic, immune stimulating, anti -hypoxic, detoxicating, bio-energetic and biosynthetic(activation of the metabolism of carbohydrates, proteins &lipids) actions.

ANTI-MICROBIAL ACTION

Oxidant action on cells

Damaging its cytoplasmicmembrane

Ozonolysis of dual bonds

How it really works on micro organisms

Healthy bacterial cell Exposed to ozone Oxidative burst

Puncturing of the walllose its shape in seconds

Death of the cell.

• It does not damage healthy human body cells becausethey have superoxide ,catalase, hydrolase and antioxidantnutrients like vitamin C &E which inhibit the uncontrolledactivity of free radicals and thus all healthy cells areprotected.

• Only unhealthy cells such as cancer cells which have lostthis protective mechanism and organisms such asbacteria, viruses, fungi, parasites which are devoid ofthese antioxidants are destroyed.

Anti –inflammatory & analgesic action:

Ozone helps in the synthesis of biologically activesubstances such as prostaglandins which isbeneficial in reducing inflammation and pain.

Immune-stimulating action:

• The electromagnetic action of ozone stimulates andmodulates immune system particularly lymphocytes.

• The application of medical ozone is extremelyuseful for immune activation of patients especiallywith a low immune status.

Anti-hypoxic action:

• Ozone brings about the rise of O2 in tissues andimproves transportation of oxygen in blood.

• Ozone acts as a super-oxygenator, bringing oxygento tissues, assisting body in its natural healingprocess.

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 developedby CurOzone Inc. (Canada)

• Subsequently manufactured under license anddistributed by KaVo Dental GmbH and Co.(Germany) under the name “HealOzone”.

HEALOZONE PROCEDURE:

The HealOzone procedure consists of a package whichincludes:

• The application of ozone gas, the use of remineralizingagents, a patient kit and information on oral hygiene.

• The HealOzone device comprises an air filter, vacuumpump, an ozone generator, a hand piece fitted with asealing silicone cup and a flexible hose.

• The procedure usually takes between 20 and 120 secondper tooth.

• Immediately after ozone application the toothsurface is treated with a remineralizing solution(reductant) containing fluoride, calcium, zinc,phosphate.

• HealOzone application for the treatment of noncavitated lesions is usually repeated at 3 and 6months.

The OzoTop :

• The OzoTop is a free flow ozone delivery system using acorona discharge.

• It is a compact, easy to use tabletop unit.

• Due to the delivery system of the OzoTop, root canals andperiodontal pockets can be penetrated easily.

• The system may be used in all cases where point ofplacement disinfection is needed, includingperiodontology, endodontology, restorative,implantology, apthous ulcers/herpes,dentures andimpression materials.

• Ozone is applied at 6, 12, 18, 24 seconds, dependingon which treatment is required.

OZONE ADMINISTRATION:

There are three basic forms of ozone application.

1. Ozone gas

2. Ozonated water and

3. Ozonated oil

These forms of application are used singly or in combinationto 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:

I. Arterial circulatory disorders

II. Immunodeficiency and Immune disbalance - Additive therapy in carcinoma patients diseases caused by viruses (e.g.,: Hepatitis)

III. Inflammatory conditions

IV. Rheumatic diseases

V. External ulcers and skin lesion

VI. External ulcers and skin lesions

VII. Dentistry.

Ozone is also used in the pharmaceutical industry, food

processing industry, fabrics and cosmetics.

CLINICAL APPLICATION OF

OZONE IN DENTISTRY:

OZONE STERILIZER

• Machines that generates ozone are known as ozonesterilizers machine.

• There are basically two type of machines are thereviz.,

Air-based

Water-based ones.

• However, they both work under the same concept asthey differ only in the method of ozone delivery.

WATER BASED OZONE

STERILIZER

For this particular type of ozonesterilizer, ozone gas are pumped intoa basin where the target items suchas meat, vegetable and fruits aresubmerged in water.

The activity of ozone occurs in thewater itself leaving coagulation ofimpurities like pesticides,herbicides, and bacteria clumpfloating on the surface and furtherbeing discarded.

This is the most preferred type ofmachine as it is multifunctional(also capable of sterilizing water),clean and simple to be used.

AIR- BASED OZONE

STERILIZATION

Unlike the water-based type, the

delivery method used in air-based

ozone sterilizer is rather simple.

Food items are placed directly into

the enclosed chamber of the

machine and ozone gas generated

are shot directly onto the surface

of the target allowing the

disinfection activity to occur in

the air.

This machine uses less power

compared to a water-based

machine.

Equipments

• Gaseous or aqueous ozone generators are commercially

available and relatively inexpensive instruments.

• Generators vary in

production capacity

from a few pounds to

hundreds of pounds of

ozone per day.

• It should be cautioned, however, that suitable treatment

chambers, monitoring devices, and excess gas destruction

units, should be designed and integrated with the ozone

generators to produce functional food treatment systems

OZONE IN ENDODONTICS

• Studies were identified investigating thebactericidal effect of ozone as compared to 2.5%sodium hypochlorite, the standard irrigationsolution in endodontics.

• The results on this outcome are controversial:while Nagayoshi et al., 2004 found nearly thesame antimicrobial activity (againstEnterococcus faecalis and S. mutans) and alower level of cytotoxicity of ozonated water ascompared to 2.5% NaOCl.

• Hems et al.,NaOCl was found to be superior toozonated water in killing E. faecalis in brothculture and in biofilms while gaseous ozone hadno effect on the E. faecalis biofilm.

• Muller et al., 2007 has also found 5%NaOClsuperior to gaseous ozone in eliminatingmicroorganisms organised in a cariogenicbiofilm.

OZONE IN PROSTHODONTICS

(1) Ozone gas can be applied as a prophylactictreatment prior to etching and the placement ofsealant with no negative impact on sound enamelphysical properties, including knoop surfacemicrohardness, or contact angle.

(2) The longer exposure to ozone gas has a strongbactericidal effect on microorganisms within thedentinal tubules of deep cavities, which could resultin increasing the clinical success of restorations,with no negative impact on dentin and enamel shearbond strength to adhesive restoration.

(3) Ozone can be applied for cleaning the surfaceof removable partial denture alloys with littleimpact on the quality of alloy in terms ofreflectance, surface roughness, and weight.

OZONE IN ORAL AND MAXILLOFACIAL

SURGERY

One study was found to evaluate the effect ofozone gas in oral and maxillofacial surgery,where ozone therapy was found to be beneficialfor the treatment of the refractory osteomyelitis

in the head and neck in addition to treatmentwith antibiotics, surgery and hyperbaric oxygen

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.

INFECTIONS:

• Soft tissue lesions like Herpes, Aphthae, Removabledenture ulcers, Cuts, Cheilitis, Candidiasis, Cysts andTraumatic wounds can be treated with eitherOzonated water or oils.

• The disinfectant and healing properties help in thehealing of these lesions.

Remineralization of Incipient Caries:

• In superficial root caries or early pit and fissurecarious lesions, ozone alone may be sufficient totreat these lesions.

• However, in situations where severe breakdown oftooth structure has occurred, ozone may be usedinitially to promote remineralization and when thishas occurred the cavity may be restored with asuitable restorative material.

Restoration of Large Cavitations Along With Conventional Conservative Measures:

• The larger lesions need special care. It must be stressedthat larger lesions are not those to be treated with ozonealone; most will require a combined approach oftraditional therapy, as well as ozone.

• Where the lesion extends deep into the dentine, the actionof ozone will take a longer time period of treatment, ormay require several treatment periods over time.

PROTOCOL

1.• The soft debris is removed along with

any unsupported enamel.

2.• If possible, denatured dentine is

removed to the leathery layer.

3.• 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 agentthen the crown is irradiated with ozone forminimum of 3-4 minutes.

• This ozone treatment bleaches the tooth withinminutes and gives the patient a happy and healthier-looking smile

Endodontic Treatment :

• The aim of conventional root canal therapy is toprovide a clean, shaped, root canal that facilitatesthe placement of an adequate root filling.

• There may be multiple canals in a single root in thissituation, current procedures can be modified, togreatly improve the quality of treatment for patients.

• When irrigating with the usual irrigant solution, forexample sodium hypochlorite, ozone can be appliedto the hypochlorite solution in the root canals.

• This technique allows the root canal system to bethoroughly disinfected and possibly be sterilized.

• Also that ozone will penetrate through the apicalforamen, and enter into the surrounding andsupportive bone tissue.

• The effect of ozone on these tissues will be toencourage healing and regeneration.

Ozonated water in decontamination of avulsed teeth before replantation:

• A high level of biocompatibility of aqueous ozoneon periodontal cells has been found.

• Two-minute irrigation of the avulsed teeth with noisotonic ozonated water not only providesmechanical cleansing, but also decontaminate theroot surface, with no negative effect on periodontalcells remaining on the tooth surface beforereplantation.

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-positiveand gram-negative oral microorganisms and oralCandida albicans.

• Gaseous ozone can be clinically useful fordisinfection of dentures.

OZONE TOXICITY:

• Ozone inhalation can be toxic to the pulmonary system andother organs.

• Complications caused by ozone therapy are infrequent at0.0007 per application.

• Known side effects are upper respiratory irritation, rhinitis,cough, headache, occasional nausea, vomiting, shortnessof breath, blood vessel swelling, poor circulation, heartproblems.

• European cooperation of medical ozone societies prohibited the intravenous injections of ozone gas due to risk of air embolism.

CURE FOR OZONE TOXICITY:

• The patient must be placed in the supine position.

• The patient should inhale the humid oxygen and treatedwith Vitamin E, & ascorbic acid.

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 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.

THANK YOU.