OZONE in dentistry

MODERATOR: DR PALLVI

PRESENTED BY :
DR. ISHANI SHARMA
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 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) and intense physical stress
on water (such as water falls & ocean waves
crashing onto rocks).
• Ozone therapy was used extensively to treat
infections, battle wounds and in routine treatment
of cancer up to 1950’s. But later the advent of
chlorine water sterilization which is more
economical declined the use of ozone .
• 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 & immune modulator as well as anti-microbial
agent.
There are three different systems for generating
ozone gas.
1. Ultra violet system: produces low concentrations of
ozone, used in aesthetics & for air purification.

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

3. Corona discharge system: produces high concentrations

of ozone. It is the most common system used in the
medical/dental field.
HISTORY:

• Christian Friedrich Schönbein (1840), a German Chemist,

is regarded as the Father of ozone therapy. When he
passed an electrical discharge through water, a strange
smell was produced, which he called Ozone, derived from
the Greek word ‘OZEIN’ which means odor.

• In 1857 Joachim Hänsler, a German physicist and

physician, along with German physician,developed the first
ozone 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 by
using O3 . Later, O3 application gained as a popularity as a
therapeutic procedure throughout Europe and America

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

diphtheria.

• In October 1893, Ousbaden, Holland became the first city

to utilize a water treatment plant using ozone.

• In World War I and II it was used to treat wounded

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

• A German dentist, Dr. E.A. Fisch, in 1950, used ozonated

water for dental procedures and pioneered its use in
medicine.
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 cytoplasmic

membrane

Ozonolysis of dual bonds

How it really works on micro organisms

Healthy bacterial cell Exposed to ozone Oxidative burst

Death of the cell. lose its shape in Puncturing of the wall

seconds
• 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)

• 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:

• The application of ozone gas, the use of remineralizing

agents, a patient kit and information on oral hygiene.

• 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.

1. Ozone gas
2. Ozonated water and
3. 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:
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 ozone
sterilizers machine.

• There are basically two type of machines are there

viz.,
 Air-based
 Water-based ones.

• However, they both work under the same concept as

they differ only in the method of ozone delivery.
WATER BASED OZONE
STERILIZER
For this particular type of ozone
sterilizer, ozone gas are pumped into
a basin where the target items such
as meat, vegetable and fruits are
submerged in water.

The activity of ozone occurs in the

water itself leaving coagulation of
impurities like pesticides,
herbicides, and bacteria clump
floating on the surface and further
being discarded.

This is the most preferred type of

machine 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 the
bactericidal effect of ozone as compared to 2.5%
sodium hypochlorite, the standard irrigation
solution in endodontics.
• The results on this outcome are controversial:
while Nagayoshi et al., 2004 found nearly the
same antimicrobial activity (against
Enterococcus faecalis and S. mutans) and a
lower level of cytotoxicity of ozonated water as
compared to 2.5% NaOCl.
• Hems et al.,NaOCl was found to be superior to
ozonated water in killing E. faecalis in broth
culture and in biofilms while gaseous ozone had
no effect on the E. faecalis biofilm.

• Muller et al., 2007 has also found 5%NaOCl

superior to gaseous ozone in eliminating
microorganisms organised in a cariogenic
biofilm.
OZONE IN PROSTHODONTICS
(1) Ozone gas can be applied as a prophylactic
treatment prior to etching and the placement of
sealant with no negative impact on sound enamel
physical properties, including knoop surface
microhardness, or contact angle.
(2) 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 to adhesive restoration.
(3) Ozone can be applied for cleaning the surface
of removable partial denture alloys with little
impact on the quality of alloy in terms of
reflectance, surface roughness, and weight.
OZONE IN ORAL AND MAXILLOFACIAL
SURGERY
One study was found to evaluate the effect of
ozone gas in oral and maxillofacial surgery,
where ozone therapy was found to be beneficial
for the treatment of the refractory osteomyelitis
in the head and neck in addition to treatment
with 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, 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 Incipient 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 need special care. It must be stressed
that 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.
PROTOCOL
• The soft debris is removed along with
1. any unsupported enamel.

• If possible, denatured dentine is

2. removed to the leathery layer.

• Ozone is applied from 40 seconds or

3. 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.
OZONE TOXICITY:
• Ozone inhalation can be toxic to the pulmonary system and
other organs.

• Complications caused by ozone therapy are infrequent at

0.0007 per application.

• Known side effects are upper respiratory irritation, rhinitis,

cough, headache, occasional nausea, vomiting, shortness
of breath, blood vessel swelling, poor circulation, heart
problems.
• 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 treated

with 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.