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1. OZONE THERAPY
IN DENTISTRY
R A B E E A K . A
F I N A L Y E A R PA R T 1

2. CONTENT
• INTRODUCTION
• HISTORY
• WHAT IS OZONE?
• HOW IS OZONE PRODUCED
• MECHANISM OF ACTION
• OZONE GENERATORS
• FORMS OF OZONE
• INDICATION
• CONTRAINDICATION
• CLINICAL APPLICATION OF OZONE
• OZONE TOXICITY
• CURE FOR OZONE TOXICITY
• CONCLUSION

3. INTRODUCTION
• Ozone is known to us as a molecule present in the atmosphere which protects us from
radiation.It also binds to the pollutants presents , hence used to measure pollution levels.
• It is a blue gas with strong odour and most importantgas in the stratosphere due to its ability
to filter UV rays which is critical for maintenance of biological balance in the biosphere

4. • 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(lightning) and intense physical stress
on water (such as water falls and ocean waves crashing into rocks)
• 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.

5. • There are 3 different systems for generating ozone gas.
1. UV system: produces low conc.Of ozone used in aesthetics and for air purification
2. Cold plasma system : used in air and water purification
3. Corona discharge system : produces high conc.Of ozone it’s the most common system used
in the medical / dental field.

6. HISTORY
• Christian Friedrich Schonbein (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 HANSLER a german physist and physician , developed the first ozone
generator for medical use
• In 1860 MONACO first used it in water treatment plants

7. • Dr.c.lender in 1870 he purified blood in test tube by using O3 Later O3 application gained
popularity as a therapeutic procedure throughoutEurope andAmerica
• In 1881.it was used as a dinfectant in the treatment of diphtheria.
• In octobor 1893 Ousbaden Holland became the first city to utilize a water treatment plant
using ozone
• In world war 1 and 2 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

8. WHAT IS OZONE ?
• Ozone (O3) is a triatomic molecule.
• 10 fold more soluble in water than oxygen.
• Ozone is not a radical molecule .
• It is the third most potent oxidant.
• It also has the capacity to stimulate blood circulation and the
immune response.

9. HOW IS OZONE PRODUCED ?
Ozone is naturally formed by the sun and lightning in stroms

10. MECHANISM OF ACTION
• There are several types
1. Antimicrobial
2. Anti inflammatory
3. Analgesic
4. Immune stimulating
5. Anti hypoxic
6. Detoxicating
7. Bio energetic
8. Biosynthetic actions

11. ANTIMICROBIAL ACTION
• The antibacterial effect of ozone occurs as a result of its oxidant action on cells by damaging
its cytoplasmic membranedue to ozonolysis of dual bonds.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 radical 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 this bacteria are
destroyed.

12. 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

13. 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 BIOSYTHETIC ACTION:
• Ozone activates mechanism of protein synthesis,increases amount of ribosomes and
mitochondria in cells elevating functional activity and regeneration potential of tissues and
organs

14. DENTAL OZONE GENERATORS
HEAL OZONE:
• Ozone is a gas that very efficiently kills cavity-causing bacteria in and on the teeth.
The HealOzone X4 unit produces ozone from oxygen by one of two methods:
• HealOzone X4 unit can produce ozone from oxygen in the ambient air (Low
Dosage mode) or from pure oxygen supplied by an oxygen bottle (High Dosage
mode).The latter method generates higher concentrations of ozone gas.
• The HealOzone X4 uses high voltage to convert oxygen into ozone.The ozone
generated by the machine is channelled through the handpiece to the affected
tooth or root canals in order to treat the carious lesions.After treatment, the
ozone gas is then suctioned off, dried and converted back into oxygen by the
ozone neutralizer.

15. 1 Oxygen supply
2 Air supply
3 Air dryer
4 Differential pressure sensor
5 Ozone generator
6 Tooth cup
7 Ozone
8 Handpiece
9 Tubing
10 Moisture trap
11 Ozone neutraliser
12Vacuum pump

16. • Immediately after ozone application the tooth surface is treated with a remineralizing solution
containing fluoride,calcium,zinc,phosphate
• Heal ozone application for the treatment of non cavitated lesions is usually repeated at 3&6
months

18. 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,gerodontology (dentures) and impression materials.
• The system utilizes ambient air,which is filtered and dried before passing over a ceramic plate
where a high voltage is applied,and ozone is produced.
• Ozone is applied at 6,12, 18,24 s, depending on which treatment is required.High-volume
suction is required as this is an open system.

19. OZONE ADMINISTRATION
• There are 3 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 years

20. Can you be allergic to
ozone ?
No , ozone is just an energized form of
oxygen

22. INDICATION
• Arterial circulatory disorders
• Immunodeficiency and Immune disbalance - Additive therapy in carcinoma patients diseases caused
by viruses (e.g.,: Hepatitis)
• Inflammatory conditions
• Rheumatic diseases
• External ulcers and skin lesion
• External ulcers and skin lesions
• Dentistry
• Ozone is also used in the pharmaceutical industry, food processing industry, fabrics and cosmetics.

23. CONTRAINDICATION
• Pregnancy
• Glucose-6-phosphate-dehydrogenase deficiency (favism)
• Hyperthyroidism
• Severe anemia
• Severe myasthenia
• Acute alcohol intoxication
• Recent myocardial infarction
• Hemorrhage from any organ
• Ozone allergy.

24. Primary pits and fissures caries
proximal caries lesions
• As a general rule , in non cavitated low speed onset lesions , a non invasive
protocol should be used first. In cavitated lesions , restoration is a must
• The tooth is treated with ozone can completely stop all caries activity and in
initial lesion even reverse the damage and allow remineralisation.

25. Hyper sensitive
teeth
• Non carious hypersensitivity is due to many contributing factors among which are erosion , bite pressure ,
recessed gum
• After elimination of the causes , ozone application might alleviate almost instantly the pain felt by the patients
from hypersensitive teeth in most cases

27. Root canal therapy
• Ozone is highly indicated in root canal therapy due to its strong disinfection property and absence of
cytotoxicity at the recommended concentration and form .
• The ozonated air can get to the narrowest places in the canal and periapical region where conventional liquids
may not be able to reach , disinfect the area and accelerate healing .
• Also it reduces the requirement of antibiotics as the region is disinfected locally .
• Ozonated oil can be used as a rootcanal dressing .

28. • Gingival and periodontal diseases represent a major concern both in dentistry and medicine.
• The majority of the contributing factors and causes in the etiology of these diseases are reduced or
treated with ozone.
• Using ozonated water generously irrigate the affected area during and after scaling , root surface planning
, and non surgical pocket curettage.
• Fill the pockets with ozonized olive oil using a blunt 25G needle or any other appropriate tip. Repeat
once a week till seen fit
Periodontal therapy

29. Results of using ozonized olive oil three days after
healing

30. TMJ PERI-ARTICULAR OZONE GAS INJECTION –
TRIGGER POINTS
• The biostimulation and anti inflammatory effects of ozone help in the management of
articulation inflammatory diseases and mascular trigger points
• Chronic oxidative stress and elevated levels of pro inflammatory cytokines are commonly
found in these skeletal chronic inflammtions where ozone gas infiltration can contribute in
stimulating the anti oxidant defense mechanism and in balancing the immune response by
modulating the production of cytokines

31. POST-EXTRACTION
• After final debridementof the socket irrigate eith copious amounts of ozonated water and
then use gauze imbibed with ozonated water to compress the extraction site.Before retiring
the patient fill the socket with ozonized oil and cover it with gauze.It improves healing and
prevents infection

32. PER-IMPLANTITIS
• Peri-implantitis is very bothering to both the dentist and the patient
• Ozone can play an important role and be used as gas or in aqueous form
• Ozonated water can also be used as an irrigant during debridementand curettage
• Also advice the patient to apply ozonized oil on the affected area 3-4 times/day

33. Results of the use of standard antiseptics and ozonated oil

34. CROWNS &BRIDGES VENEERS
• A common occurrence we sometimes see during the temporization phase in crowns
,inlays/onlays and veneers procedure is hypersensitivity
• Many factors might contribute in this event one of which is the presence of bacteria left inside
the presence of bacteria left inside the opened dentinal tubules during preparation its is
paramount to remove the smear layer and disinfect the prepared teeth before temporization
and before seating of the final restoration

35. USE OF OZONATED AIR BEFORE TEMPORIZATION AND CEMENTING THE FINAL
PROSTHESIS

36. • All kinds of infectious , inflammatory , traumatic , burns , wounds , soft tissue lesions respond very well to topical
ozone treatment .
• The infected area is sealed with a PVC or silicone cap and ozone gas applied for1-2 minutes . In larger areas
aqueous ozone is also used . Repeat if necessary.
• In case of cyst fistula , insert a plastic needle slowly in the passage of the fistula and inject 1-2 cc of ozone gas
• In many instances , daily at home application of ozonized olive oil is required .
SOFT TISSUE LESIONS

37. Effect of ozone therapy on soft tissue lesions

38. Comparison oflowlevellaser therapyversus ozonetherapyin the
treatment oforal lichenplanus
Background
The treatment options for OLP are numerous and include topical and systemic agents . Intralesional and systemic
corticosteroids are used ,however , the therapeutic results are often disappointing.
Objective
To compare the influence of ozone , laser ,and topical corticosteroid therapies in the treatment of OLP
Results
the study subjects consisted of 56 male and 64 female OLP patients with a combined mean age of 42.6 years . No
statistically significant difference was detected in clinical severity among the groups. the sign scores decreased in almost
all scoring groups . Howeverstatistically significant improvement was found in the ozonated and corticosteroid treated
groups.

39. Symptom improvement was achieved after treatment with LLLT,ozone , and corticosteroid, the efficacy
indices were significantly higher in the ozonated and corticosteroid treated groups .
Conclusion
ozone and corticosteroid therapies were more effective than 808 nm LLLT in the treatment of OLP .

40. Whitening with ozone
Due to the strong oxidation power of ozone, researches started looking on the ability of ozone to white teeth.
The results so far are promising.

41. ROLE OF OZONE IN ORTHODONTICS
• In orthodontic treatments, diffuse opacity of enamel is commonly seen due to the effect of bonding
material on enamel surface, as well as white spot lesions have been seen in first 4 weeks of the
treatment.
• White spot lesion formation usually begins at bracket and toot interface and can reach beneath the
bracket area. Hence, prophylactic therapy of enamel has an immense importance in orthodontic
treatments.
• Ghobashy et al. studied on reducing demineralization of enamel bonded to the orthodontic bracket
using ozonized olive oil. Patients who used ozonized olive oil gel with traditional oral hygiene
instructions had significantly less decalcification areas during the orthodontic treatment.

42. ROLE OF OZONE IN PEDODONTICS
• The use of ozone has positive effects on children,especially in terms of cooperation,such as
not making noise,having very small hoods, not generating heat or bad smell, water spray or
loud sounds of suctions,and not needing hand tools . Ozone prevents the caries formation via
inhibiting the reproduction of pathogenic microorganisms,or destroying the cell wall by
neutralizing or blocking
• During this time,ozone attacks glycoproteins,glycolipids,and other amino acids and blocks
enzymatic control systems of cells.Thus, the permeability of the cell membrane increases,
extending to stop cell viability.After that,the ozone molecules can quickly enter the cell and
cause the death of microorganisms
• ozone is an oxidative agent and can provide remineralization of demineralized dentin

43. OZONE TOXICITY
• Overwhelming evidence shows that the bronchial-pulmonary system is very sensitive to ozone
and this gas should never be inhaled.
• The respiratory tract lining fluid is constituted by a very thin,watery film containing a minimal
amount of antioxidants that makes mucosal cells extremely vulnerable to oxidation.
• Pulmonary embolism,which occurred during direct intravenous administration of O 2 /O 3 ,
an application prohibited by the European Society of Ozonetherapy since 1983. Known side
effects are epiphora and upper respiratory irritation,rhinitis,cough,headache,occasional
nausea,and vomiting.

44. • Pathological and anatomical studies showed that blood clotting is impaired in a typical table
ozone poisoning and has been shown to occur in lung hematomas.However,the ozone gas is
not a chemical disinfectant,and after completing the disinfection task due to its unstable
structure,it rapidly transforms into oxygen

45. CURE FOR OZONE TOXICITY
• The patient must be placed in the supine position
• administering supportivetreatment such as oxygen,ascorbic acid,vitamin E, and N-
acetylcysteine to the patient would be beneficial

46. Modern dentistry is all about non /minimal invasive dentistry . Ozone therapy in the present stage is reducing caries
activity , improving periodontal health, and also improving the healing time of oral lesions and wounds.
Besides atraumatic application and antimicrobial effects of ozone, carrying toxic risk and can have deadly consequences
of wrong actions also incomplete understanding of the mechanism of action many clinicians approach suspicious to
ozone. Considering the studies done so far,it can be said that ozone can be used as an additional application besides
applications such as antiseptics and local antibiotics, which are given in addition to dental treatments.
ozone therapy is bound to revolutionize the way dentistry is going to
be practiced in the future .
CONCLUSION

47. THANK YOU