origin, history, mechanism of action, its uses in medicine and dentistry especially in periodontics, its half life and its disinfection action on covid-19

1. OZONE
THERAPY IN
PERIODONTICS
DR. GULAFSHA M
Post Graduate
Dept of Periodontology
1

2. CONTENTS:
 Introduction
 History
 Goals Of Ozone Therapy
 Chemistry
 Mechanism Of Action
 Dental Ozone Generators
 Appliances Producing Ozone For Dental Use
 Ozone Administration
 Advantages
2

3.  Disadvantages
 Indication
 Contraindications
 Clinical Application Of Ozone
 Ozone Toxicity
 Cure For Ozone Toxicity
 Conclusion
 References
3

4. INTRODUCTION:
• Oxygen is the primary requisite for life. It essential for all aerobic organisms and contributes to
the formation of fundamental organic molecules together with hydrogen, carbon, nitrogen and
sulphur.
• Adequate delivery of oxygen to the wound tissue is vital for optimal healing and resistance to
infection.
• Since time immemorial research has focused on treating wound and infection with different
molecules of oxygen such as Hyperbaric oxygen and Ozone therapy.
4

5. • For over 130yrs, millions of people have benefited from the effects of ozone to eliminate disease and
encourage natural healing.
• It 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.
• Ozone therapy is used to disinfect and treat diseases by limiting the effect of bacteria, viruses, fungi,
yeast and protozoa.
5

6. PRINCIPLE
Oxygen molecule is stroked by high energy ultraviolet (UV)
radiation, it splits into two free oxygen atoms, further these free
oxygen atoms collide with oxygen molecules leading to the
production of ozone. That can be used for treating various
diseases.
O2+UV O + O
O + O2 O3
6

7. • Occupational exposure to ozone occurs through its production by office
photocopying equipment, electric arc welding, mercury vapour lamps, laser
printers, X-ray generators and high voltage electrical equipment etc.
• Ozone therapy was used extensively to treat infections, battle wounds and in
routine treatment of cancer upto 1950’s.
• But later the advent of chlorine water sterilization which is more economical
declined the use of ozone.
7

8. • 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.
• Multiple microbiological & the biochemical studies
justified that there are no doubts about the effectiveness
of ozone in bacterial reduction
8

9. • In 1785, Van Marum noticed that air near his
electrostatic machine acquired a characteristic odor
when electric sparks were passed.
• In 1801, Cruickshank observed the same odor at the
anode during electrolysis of water
HISTORY:
9

10. • 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, developed the first ozone
generator for medical use.
• In 1860, Monaco first used it in water treatment plants .
Christian Friedrich Schönbein
10

11. • 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, Wiesbaden, 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 .
11

12. • 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.
12

13. Goals of
Ozone
Therapy
1. Elimination of
pathogens.
2. Restoration
of proper
oxygen
metabolism.
3. Induction of a
friendly
ecologic
environment.
4. Increased
circulation.
5. Immune
activation.
6. Simulation of
the humoral
anti-oxidant
system.
13

14. • Medical grade ozone is a mixture of pure O2 and O3 in the ratio of 0.1% to 5% of O3 and 95% to
99.5% of O2.
• Depending on the conditions like temperature and pressure, ozone is highly instable compound
with half- life of 40 mins at 200 C.
Hattur A, Shrisel S. Ozone Therapy: An Excellent Treatment for Various Diseases. Ijppr. Human, 2017; 10(3): 303-311 14

15. CHEMISTRY:
Ozone (O3 ) is a
triatomic molecule,
consisting of three
oxygen atoms.
Its molecular weight is
4,798 g/mol and
thermodynamically highly
instable compound that,
dependent on system
conditions like
temperature and
pressure, decompose to
pure oxygen with a short
half life.
Ozone is 1.6-fold
denser and 10-fold
more soluble in water
(49.0 mL in 100 mL
water at 0˚ C) than
oxygen.
Ozone is an unstable
gas that cannot be
stored and should be
used at once because it
has a half-life of 40 min
at 20 ˚C.
15

16. MECHANISM OF ACTION
Ozone reacts with bio-molecules producing one molecule of reactive oxygen
species (ROS) mainly hydrogen peroxide and two molecules of lipid oxidation
product (LOP).
ROS react with erythrocytes in the blood and disappears. This is called early
phase reaction and it is short lived.
LOPs distributed to tissues and act on receptors at the different location on
the body. They undergo marked dilution under circulation system. This is
called late phase reaction and it lasts longer.
Ozone therapy as a non-surgical alternative form of the medical treatment helps to reduce clogging of blood cells, detoxify
the liver, decrease uric acid in the body, improves circulation and oxygen supply, kill viruses, fungi, and bacteria, also increase
the activity ofWBCs.
16

17. There are several actions of ozone such as:
• Anti-microbial
• Anti-inflammatory
• Analgesic
• Immune Stimulating
• Anti –Hypoxic
• Detoxicating
• Bio-energetic and biosynthetic.
17

18. Anti-microbial
Immunostimulating
effect
Anti-hypoxic effect
 Bacteria, fungi, and viruses are destroyed with O3
application. The ozonolysis of dual bond of the outer
cytoplasmic membrane and modification of intracellular
content because of secondary oxidative effect leads to
oxidation of proteins.
 Ozone stimulates the cellular and humoral immune
system and hence proliferation of immunocompetent cells
and immunoglobulin synthesis.
 Ozone results in change of cellular metabolism by raising
partial pressure of oxygen in tissues and improving the
transportation of oxygen in blood.
18

19. Anti-inflammatory
and analgesic action
Biosynthetic effect
 Ozone helps in the synthesis of biologically active
substances such as prostaglandins which is beneficial in
reducing inflammation and pain.
• Ozone causes activation of protein synthesis mechanism
with increased amount of mitochondria and ribosomes in
cells that leads to elevation of functional activity and
regeneration potential of tissues and organs.
19

20. • Vasodilators (nitric oxide) that are responsible for dilatation of arterioles and venules are
secreted by ozone.
• Ozone intensifies remineralization potential when acting on the organic substance of
mineralized tooth tissues.
• Also enables the diffusion of calcium and phosphorus ions to the deeper layers of carious
cavities by opening of the dentinal tubules
20

21. OZONE GENERATORS:
• Since ozone is very unstable, it has to be generated only when needed and used at once.
• The first ozone generator was developed by Werner Von Siemens in Germany in 1857.
• Three different systems:
• 1. Ultraviolet system: Produces low concentrations of ozone. It is used in esthetics, saunas and for
air purification.
• 2. Corona discharge system: Produces high concentrations of ozone. Most common system used in
medical and dental field.
• 3. Cold plasma system: Used in air and water purification
21

22. Appliances producing ozone for Dental use
• HealOzone by KaVo
• OzonyTron by MYMED Gmb H.
• Product photo (Prozone) by W&H.
22

23. Appliances producing ozone for dental use
• HealOzone by KaVo: It is an air-based system in which gas is applied in a closed circuit.
• OzonyTron by MYMED Gmb H: Oxygen activation generator (OzonytronX—Biozonix,
München, Germany) uses the power of high frequency and voltage. There is no closed
circuit here, therefore, ozone can be applied to the places that are difficult to reach, e.g.
gingival pockets or root canals.
• Product photo (Prozone) by W and H: Prozone is easy to use and safe to apply as the
tissue compatible dosages can be preset according to the indication areas of
endodontics and periodontics. A hygienic procedure is ensured during the gassing of the
pockets as the plastic attachments (Perio tips or Endo tips) are exchangeable.
23

24. • Ozotop: It is a compact, easy to use table top unit having a free flow ozone delivery system which
utilizes corona discharge. Root canals and periodontal pockets could be easily penetrated.
• Customized thermoformed dental appliance: For application of ozone gas hard- or medium-soft
thermoformed dental appliance could be prepared which extends 2–3 mm beyond the affected
gingival area and a free space for gas circulation is left.
24

25. • Irrigation with ozonated water: As ozone water is highly effective in killing of both Gram-positive
and negative micro-organisms, areas affected during and after SRP and non-surgical pocket
curettage might be irrigated with ozone water. In plaque biofilm, the bactericidal activity of ozone
water against bacteria is strong.
• Ozone Nano bubble water: If protected against UV rays exposure, the oxidation ability of NBW3 is
retained as aqueous ozone for more than 6 months.
• In-office and home use of ozonized olive oil: A blunt 25-G needle or any other appropriate tip can
be used to fill pockets with ozonized olive oil and the application can be repeated once a week.
25

26. Routes of Administration of Ozone
1. Auto Hemotherapy:
2. Insufflations:
3. Ozone Bagging:
4. Ozone Blanket:
5. External Administration of ozone:
6. Parenteral methods:
7. Enteral Method:
8. Steam Sauna:
9. Body Suit:
Three basic forms of ozone application:
1. ozone gas
2. ozonated water and
3. ozonated oil
26

27. 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.
27

28. Advantages
Disinfectant.
Anti-inflammatory.
Activation of intracellular
metabolism of oral mucosa
and dental wounds.
Improvement of regional
circulation.
Stimulation of regenerative
processes.
Hemostasis in capillary
bleedings.
Painless procedures. 28

29. Disadvantage
s
Ozone toxicity if the level
increases at 0.0007% per
application.
Instability.
Not readily available
29

30. Indications:
Chronic or recurrent infections in the
oral cavity.
Sterilization of cavities, root canals,
periodontal pockets, herpetic lesions.
Desensitization of extremely sensitive
tooth necks.
Pre-washing of surgical sites.
Plaque control.
Contamination control.
30

31. Contraindications:
Pregnancy
Ozone
allergy.
Hyperthyroidi
sm
Severe
anemia
Thrombocyto
penia
Cardiovascul
ar instability
31

32. Uses of Ozone In Dentistry
• Conservative dentistry: Enamel cracks, Tooth whitening, Dentinal hypersensitivity, abscess, granuloma,
remineralization of pit and fissure caries, root and smooth surface caries, bleaching of discolored root canal
treated teeth, Sterilization of cavities, Root canals.
• Oral surgery: After a tooth is extracted or any surgical procedure the area is irrigated and insufflated
with ozone promotes faster healing without complications.
32

33. • Oral medicine: 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.
• Prosthodontics: Gaseous O3 is proved to be clinically useful for disinfection of dentures.
• Orthodontics and orthopedics: Application of ozone in water and gaseous form into the TMJ
dysfunctions or for myoarthropathy can cause relaxation of muscles.
33

34. Ozone therapy in periodontics
 Periodontitis being multifactorial disease process in the mouth has the role of
microorganisms, host response, in its etiology.
 The undisputed disinfection power of ozone over other antiseptics makes the use of ozone
in treatment of periodontitis, gingivitis, peri implantitis, surgical cuts, Prophylaxis.
 Very good alternative and/or an additional disinfectant to standard antiseptics.
34

35. • Repeated application of ozone spray for 60s followed by mineral wash on the exposed dentine
provides quick and prompt relief from root sensitivity.
• Gaseous or aqueous form of ozone may be used in cases of peri-implantitis.
• 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
35

36. 36

37. Ozonated water
Efficacious against Gram-positive and
Gram-negative oral microorganisms as well as
bacteria in plaque biofilm.
It may be used as a mouth rinse in cases of
gingivitis, oral thrush or stomatitis, as a spray to
cleanse the affected area and to disinfect oral
mucosa.
1. Gupta G, Mansi B. Ozone therapy in periodontics. Journal of Medicine and Life, Feb 22, 2012; 5(1): 59.
2. Gupta S, Deepa D. Applications of ozone therapy in dentistry. Journal of Oral Research and Review, Jul 1, 2016; 8(2): 86.
37

38. Ozonized oil
• Competitive antimicrobial agent.
• Efficacious against Streptococci, Enterococci, Staphylococci,
Pseudomonas, Escherichia coli and especially Mycobacteria and is used
for the cure of fungal infections.
38

39. Ozone Gas
• 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.
39

40. Ebensberger et al., 2002 found that 2 min
irrigation of avulsed tooth with ozonated
Water (4mg/l) leads to mechanical
cleansing, decontaminates the root
surface, no negative effect on periodontal
cells remaining on the tooth surface.
Gupta S, Deepa D. Applications of ozone therapy in dentistry. Journal of Oral Research and Review, Jul 1, 2016; 8(2): 86.
40

41. Gram negative bacteria, such as
Porphyromonas endodontalis and
Porphyromonas gingivalis were
substantially more sensitive to ozonated
water than gram positive oral streptococci
and C. albicans in pure culture.
Furthermore ozonated water had strong
bactericidal activity against bacteria in
plaque biofilm.
Nagayoshi et al.
2004 tested the
efficacy of ozonated
water on survival and
permeability of oral
micro-organisms.
41

42. Similarly Ramzy et al., 2005
found that patients suffering
from aggressive periodontitis
were irrigated with 150 ml of
ozonized water over 5-10 min
once weekly using a blunt
tipped sterile plastic syringe
showed significant
improvement regarding
pocket depth, PI, GI and
reduction in bacterial count
reported in sites treated with
ozonized water
Ramzy M. I, Gomaa H. E, Mostafa M. I and Zaki B. M. Management of aggressive periodontitis using ozonized water. Egypt Med
JNR C, 2005; 6(1): 229-45.
42

43. Huth et al. in 2006, in their study declared that the
aqueous form of ozone, as a potential antiseptic agent,
showed less cytotoxicity than gaseous ozone or established
anti microbials.
Therefore, aqueous ozone fulfills
optimal cell biological characteristics
in terms of biocompatibility for oral
application.
43

44. Only 5% hypochlorate solution
was able to eliminate all
bacteria effectively. Usage of
gasiform ozone or PDT was not
able to reduce bacteria in the
biofilm.
They concluded that the
matrix-embedded microbial
populations in biofilm are well
protected towards
antimicrobial agents.
Muller et al. in 2007 compared the influence of ozone gas with
photodynamic therapy (PDT) and known antiseptic agents (2%
chlorhexidine, 0.5 and 5% hypocholrate solutions) on a multispecies oral
biofilm in vitro using gasiform ozone.
44

45. Kshitish and Laxman
in 2010 conducted a
randomized, double-
blind, crossover split-
mouth study on 16
patients suffering from
generalized chronic
periodontitis.
They concluded that
despite the substantivity
of chlorhexidine, the
single irrigation of ozone
is quite effective to
inactivate
microorganisms.
45

46. Huth, et al. in 2011 compared the
effectiveness of ozone with CHX, against
periodontal microorganisms. There were
no significant differences in the
effectiveness of aqueous ozone (20 μg ml
[−1]) or gaseous ozone (≥4 g [−3])
compared with 0.2% CHX but they were
more effective than 0.2% CHX.
Therefore, high-concentrated
gaseous and aqueous ozone
merit further investigation as
antiseptics in periodontitis
therapy.
46

47. • Dodwad et al. in 2011 compared the effect of oral irrigation with ozonated water, 0.2%
Chlorhexidine and 10% Povidone iodine in patients with chronic periodontitis.
• The study concluded that local ozone application can serve as potent atraumatic,
antimicrobial agent to treat periodontal disease non-surgically both for home care and
professional practice. It may also serve as good tool during supportive periodontal
therapy.
47

48. Sadatullah et al in 2012 analysed the effect of 0.1 ppm ozonated water on 24-hour
supragingival plaque (SP) samples.
Ozonated water at the 0.1 ppm concentration was effective in reducing the load of 24-hour plaque
bacteria, but it did not eliminate them completely.
48

49. Hayakumo et al.,
2013 found that
subgingival irrigation
with NBW3 is valuable
adjunct to periodontal
treatment.
Since ozone has a half-
life of 20 mins, to
overcome this
disadvantage ozone
nano bubble water
(NWB3) was developed
using nano-bubble
generating technology.
Hayakumo S. Clinical and microbiological effects of ozone nano-bubble water irrigation as an adjunct to mechanical
subgingival debridement in periodontitis patients in a RCT. Clinical Oral Investigations, Mar 1, 2013; 17(2): 379-88.
49

50. Ylmaiz et al in 2013 evaluated the
clinical and microbiological results of
treatment with the Er:YAG laser and
topical gaseous ozone application as
adjuncts to initial periodontal therapy
in chronic periodontitis (CP) patients. ozone has an antimicrobial effect equivalent
to that of the Er:YAG laser.
50

51. Punit vaibhav et al in
2013 in a case report A
42-years female patient
was selected, who
presented with a mild to
moderately painful,
exophytic, fibrous lesion
on the upper anterior
gingiva.
Topical ozone therapy
provides potential
benefits for the
treatment of
exophytic gingival
lesions.
51

52. • Shoukeba et al in 2014 found that ozonated olive oil gel could be a promising adjunct to SRP in
treatment of aggressive periodontitis.
52

53. Habhasneh et al in 2014 aimed
to determine the clinical and
biological effects of the adjunctive
use of ozone in nonsurgical
periodontal treatment.
Irrigation with
ozonated water as an
adjunctive therapy to
SRP produces no
statistically significant
benefit compared
with SRP plus distilled
water irrigation.
53

54. • Kl Vandana et al in 2015 assessed the effect of chlorhexidine (CHX), povidone
iodine (PI), and ozone (OZ) in microorganisms aerosols.
• The study concluded that CHX, PI and OZ showed similar effects in reducing
aerobic and anaerobic CFU's at the chest mask and at 9 ft. OZ can be used as a
preprocedural agent, considering its beneficial effects.
54

55. 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
55

56. OZONE FOR TREATMENT OF
PERIIMPLANTITIS
• El Hadary et al in 2011 evaluated the effect of ozonated oil under the influence of cyclosporine A
in bone integration of dental implants.
• The administration of short term cyclosporine together with the topical application of ozonated oil may
influence bone density.
56

57. • Hauser gerspach et al in 2012 investigated the antimicrobial efficacy of gaseous ozone on
bacteria adhered to several surfaces of titanium and zirconium.
• Ozone treatment was carried out with an ozotop unit, 140ppm; 2L/min for 6-24 sec. p.
gingivalis was eliminated in 24 seconds with ozone. S Sanguinis was more resistant and
showed greater reduction in zirconium substrates.
57

58. • Mc Kenna et al in 2013 assessed the effect of subgingival ozone and/ or H2O2 on the
development of peri implant Mucositis.
• ozone showed great potential for management of peri implant Mucositis.
58

59.  One study concluded that the addition of ozone to a ultrasonic cleaning system containing
different experimental solutions resulted in antibacterial activity against Staphylococcus aureus.
 Ozonated water has an excellent anti- inflammatory capacity.
 The use of ozone around implants is supported by published research showing that ozone not only
effectively sterilizes the surfaces of both the implant and bone, but also initiates the reparative
mechanisms allowing tissue regeneration around implant surface.
59

60. 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.
• Despite proponents for ozone use and the potential
applications, toxicity can occur even at environmental
levels and may be related to cardiac, respiratory, and
neurologic events.
• Certain side-effects such as cough, nausea, vomiting,
headache, epiphora, rhinitis, upper respiratory
irritation, shortness of breath, and heart-related
problems.
• European cooperation of medical ozone societies
prohibited the intravenous injections of ozone gas due
to risk of air embolism.
60

61. Ozone
Intoxification
• Administration of 0.05 ppm for 8 h ozone is not toxic.
• 0.01 ppm concentration of ozone can be used in oral
cavity during ozone therapy.
• In case of ozone toxicity, patient must be placed in
supine position and made to inhale humid oxygen.
• Oral intake ofVitamin E is beneficial to the chronic
ambient exposure.
• Budesonide has been shown to inhibit the airway
neutrophilic inflammatory response although it does
not prevent functional impairment of the airway.
61

62. • Ozone has a 99% effectiveness when killing pathogens like the flu, SARS, and the Coronavirus.
• According to the WHO, coronaviruses are a large family of viruses that cause illnesses ranging from
the common cold to more severe diseases such as Middle East Respiratory Syndrome (MERS-CoV)
and Severe Acute Respiratory Syndrome (SARS-CoV).
• The new coronavirus is considered an “enveloped virus.”
• Enveloped viruses are usually more sensitive to physico-chemical challenges. In past studies, 99% of
viruses have been damaged or destroyed after 30 seconds of exposure to ozone.
• Ozone destroys viruses by diffusing through the protein coat into the nucleic acid core, resulting in
damage of the viral RNA. At higher concentrations, ozone destroys the exterior protein shell by
oxidation.
• When disinfecting large areas, ozone gas has been proven to kill the SARS coronavirus. Because the
structure of the new 2019-nCoV coronavirus is almost identical, it is somewhat safe to believe that
it will also work on the new coronavirus.
• Currently, there are more than 17 scientific studies that prove ozone gas can destroy the
SARS coronavirus. 62

63. CONCLUSION
63

64. REFERENCES
• Clinical and microbiological effects of ozone nano-bubble water irrigation as an adjunct to mechanical
subgingival debridement in periodontitis patients in a randomized controlled trial, Sae Hayakumo,
Clinical Oral Investigations March 2013, Volume 17, Issue 2, pp 379-388.
• Effect of chlorhexidine, povidone iodine, and ozone on microorganisms in dental aerosols: Randomized
double-blind clinical trial, Ravleen Kaur, Year : 2014,Volume : 25,Issue : 2, Page : 160-165.
• Ozone Therapy : A New Revolution In Periodontics, Dr. Pradeep Chitnis, IJRD, May, 2013 Vol 2 Issue 5.
• The antimicrobial effect of 0.1 ppm ozonated water on 24-hour plaque microorganisms in situ, syed
sadatullah, Braz. oral res. vol.26 no.2 São Paulo Mar./Apr. 2012
• Ozone and its use in periodontal treatment, open journal of stomatology, 2013,3, 197-202.
• Ozone in periodontics, natural remedy in dentistry, journal of dental herald, 2014.
64

65. • Current concepts of oxygen ozone therapy for dentistry, john a rotchfield.
• Ozone therapy: a new paradigm in periodontitis, journal of advanced medical and dental sciences
research, 2014.
• Ozone in dentistry: microbiological effects of gas action depending on the method and the time of
application on using the ozonytron device, experimental study, katarzyna, annals academia medial,
2011.
• The effect of subgingival ozone and or H2O2 on the development of periimplant mucositis: a double
blind randomized controlled trial, danial f Mc Kenna, the international journal of oral and
maxillofacial implants.
• Gulafsha M, Anuroopa P. Miracle of ozone in dentistry: an overview. World J Pharm Res. 2019 Jan
9, 8: 665-77
65

66. THANK YOU
66