Introduction

---

Ozone is a natural gaseous molecule made up of three oxygen atoms. The word ozone originates from the Greek word ozein, which means odor and was first used by German chemist Christian Friedrich Schonbein, father of ozone therapy (1799-1868) in 1840 when, working with a voltaic pile in the presence of oxygen, noticed the emergence of a gas with an “electric and pungent smell” that could be a sort of “super-active oxygen”.[1] Industrial ozone generators are used for industrial application and disinfection of water, after it was shown the potent and broad bactericidal activity of ozone. The first medical application seems to have been the use of ozone for treating gaseous, post-traumatic gangrene in German soldiers during the 1st world war.[2] However a big step forward was the invention of a reliable ozoniser for medical use by the physicist Joachim Hansler (1908-1981). The idea to use ozone in medicine developed slowly during the last century and it was stimulated by the lack of antibiotics and the disinfectant properties of ozone. Ozone, which is used for medical purposes, is a gas mixture comprised of 95 to 99.95% oxygen and 0.05 to 5% pure ozone. Due to proven therapeutic advantages of ozone, many fields in dentistry could benefit from ozone therapy. From the historical data, the first dentist who used ozone was Edward Fisch in 1950 when he healed Austrian surgeon Ernst Payr for a gangrenous pulpite and thereby inspired him to begin a line of investigations dedicated to ozone use in health care, reported his results at the 59th Congress of the German Surgical Society in Berlin (1935) and wrote: “which other disinfectant would be tolerated better than ozone? The positive results in 75% of patients, the simplicity, the hygienic conditions and innocuity of the method are some of the many advantages”.

Ozone Generation

---

Joachim Hänsler and Hans Wolff, German physicians, developed 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. There are three different systems for generating ozone gas:
Ultraviolet System: produces low concentrations of ozone, used in esthetics, saunas, 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.
Commercially available ozone generator: CurOzone USA Inc. (Ontario, Canada) developed the HealOzone, which is now distributed by KaVo Dental (KaVo, Biberach, Germany), for use in dentistry.
Mode of delivery:
The route of ozone administration is topical or locoregional in gaseous or aqueous form or as ozonated olive or sunflower oil.

Applications of Ozone in Dentistry

---

The use of ozone has been proposed in dentistry because of its antimicrobial, disinfectant, biocompatibility and healing properties. Ozone has been applied for treatment of early carious lesions, sterilization of cavities, root canals, periodontal pockets, enhancing epithelial wound healing such as ulcerations and herpetic lesions, Bleaching of discoloured root canal treated teeth, Desensitization of extremely sensitive teeth, treatment of periimplantitis, and as a rinse for the avulsed teeth or as a denture cleaner and decontamination of used tooth brush.
Caries prevention [3,4,5,6,7]
Ozone can be used to kill bacteria present in carious lesion, painlessly and even without anaesthetic. 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 demineralized part and this demineralized tooth structure then, can be remineralized using a special remineralization kit, containing Calcium, Fluorine, Phosphorus and Sodium, all in their ionic forms.
Endodontic treatment [8,9,10]
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.
Periodontal treatments:[11,12]
Ozonated water strongly inhibited the accumulation of dental plaque. Ozonated oil is used as a safe therapeutic alternative in patients with Acute Necrotizing Ulcerative Gingivitis. Healing and bactericidal properties makes it useful as a subgingival irrigant.
Healing wounds: [13]
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. 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. In alveolitis , there is accelerated healing by irrigation with ozonated water after removal of the necrotic pulp & debris under antibiotic coverage.
Bleaching [14]
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. Also, capping the tooth with ceramic crown is not always a good idea. But, now, ozone has the answer to all these questions.
Ozone can be successfully used for lightening the yellowish tinge of tetracycline-stained rat incisors.
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. Smear 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.
Ozones in Prosthodontics:
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. 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. 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. Gaseous ozone is used to disintegrate smear layer and to disinfect the prepared tooth. Denture stomatitis can be controlled by topical application of ozonated oil over tissue surface and over denture surface.
Decontamination of tooth brush:
Ozone application was found to remove the toothbrushes bristles microbiota following conventional brushing.

Contraindications of ozone

---

The following are contraindications of ozone therapy

1. Pregnancy
2. Glucose- 6- phoshate dehydrogenase deficiency (favism)
3. Hyper thyroidism
4. Severe anemia
5. Severe myasthenia
6. Active hemorrhage

References

---

1.Velio Bocci. OZONE  A New Medical Drug. 2005, Springer publications.
2.Bocci V. Ozone as Janus: this controversial gas can be either toxic or medically useful.  Mediators of Inflammation 2004;13:3.
3.Hickel R, Huth C. Initial therapeutic impressions of the use of Ozone for the treatment of caries. Deutscher Zahnarzte Kalender 2004; 1-10
4.Celiberti P, Pazera P, Lussi A. The impact of ozone treatment on enamel physical properties. Am J Dent. 2006; 19(1):67-72.
5.Baysan A, Whiley R, Lynch E. Anti microbial effects of a novel ozone generating device on microorganisms associated with primary root carious lesion in vitro. Caries Res. 2000; 34:498-501.
6. Baysan A, Beighton D. Assessment of the ozone-mediated killing of bacteria in infected dentine associated with non-cavitated occlusal carious lesions. Caries Res. 2007; 41:337-341
7.Abu-Nab’a L, Shorman AL, Lynch E. Ozone treatment of primary occlusal pit and fissure caries. Caries Res 2003; 37: 272.
8.Nogales CG. [Ozonetherapy: Medical and Dentistry application] [Dissertation]. São Paulo (Brazil): University of São Paulo; 2006.
9.Nagayoshi M, Kitamura C, Fukuizumi T, Nishihara T, Terashita M. Antimicrobial effect of  ozonated water on bacteria invading dentinal tubules. Journal of Endodontics 2004;30:778.
10.Estrela C, Estrela CRA, Decurcio DA, Hollanda ACB, Silva JA. Antimicrobial efficacy of ozonated water, gaseous ozone, sodium hypochlorite and chlorhexidine in infected human root canals. Int Endod J. 2007; 40:85-93.
11.Nagayoshi M, Kitamura C, Fukuzumi T, Nishihara T, Terashita M. Efficacy of ozone on survival and permeability of oral microorganisms. Oral Microbiology and Immunology 2004; 19:240-6.
12.Kshitish D, Laxman VK The use of ozonated water and 0.2% chlorhexidine in the treatment of periodontitis patients: a clinical and microbiologic study.. Indian J Dent Res. 2010 Jul-Sep;21(3):341-8.
13.Valacchi G, Lim Y, Belmonte G, Miracco C, Zanardi I, Bocci V, Travagli V Ozonated sesame oil enhances cutaneous wound healing in SKH1 mice.Wound Repair Regen. 2011 Jan;19(1):107-15.
14.Tessier J, Rodriguez PN, Lifshitz F, Friedman SM, Lanata EJ. The use of ozone to lighten teeth. An experimental study. Acta Odontol Latinoam. 2010;23(2):84-9.

Source(s) of Funding

---

Self funded

Competing Interests

---

None

Disclaimer

---

This article has been downloaded from WebmedCentral. With our unique author driven post publication peer review, contents posted on this web portal do not undergo any prepublication peer or editorial review. It is completely the responsibility of the authors to ensure not only scientific and ethical standards of the manuscript but also its grammatical accuracy. Authors must ensure that they obtain all the necessary permissions before submitting any information that requires obtaining a consent or approval from a third party. Authors should also ensure not to submit any information which they do not have the copyright of or of which they have transferred the copyrights to a third party.
Contents on WebmedCentral are purely for biomedical researchers and scientists. They are not meant to cater to the needs of an individual patient. The web portal or any content(s) therein is neither designed to support, nor replace, the relationship that exists between a patient/site visitor and his/her physician. Your use of the WebmedCentral site and its contents is entirely at your own risk. We do not take any responsibility for any harm that you may suffer or inflict on a third person by following the contents of this website.