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Table of Contents
ORIGINAL ARTICLE
Year : 2019  |  Volume : 6  |  Issue : 1  |  Page : 14-16

Efficacy of ozone therapy as an adjunct to scaling and root planing: A clinical and microbiological study


1 2nd Year Post Graduate, Department of Periodontics, Mansarovar Dental College, Bhopal, Madhya Pradesh, India
2 Reader, Department of Periodontics, Mansarovar Dental College, Bhopal, Madhya Pradesh, India
3 Professor and Head, Department of Periodontics, Mansarovar Dental College, Bhopal, Madhya Pradesh, India
4 Professor, Department of Periodontics, Mansarovar Dental College, Bhopal, Madhya Pradesh, India

Date of Web Publication26-Jul-2019

Correspondence Address:
Dr. Richa Agrawal
Department of Periodontics, Mansarovar Dental College, Bhopal, Madhya Pradesh
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/INPC.INPC_26_19

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  Abstract 


Introduction: Periodontitis is a multifactorial disease, of which bacterial plaque is the main cause for the initiation and progression of periodontitis. Elimination of bacterial colonization is the main objective of periodontal therapy. Scaling and root planing (SRP) has been the main treatment modality, but inaccessibility into deep pockets can leave residual deposits in the pocket resulting in recolonization pathogenic organisms in treated areas. This led to the use of antibacterial agents as subgingival irrigants as an adjunct to SRP. Ozone is known for its antimicrobial effect.
Materials and Methods: Forty sites with probing pocket depth ≥6 mm were included in the study. The test sites were subjected to ozonized water subgingival irrigation, and control sites were subjected to subgingival irrigation 0.2% chlorhexidine. The clinical parameters were recorded initially and after 1 month along with microbiologic sampling.
Results: Baseline values showed no statistically significant difference in any of the clinical parameters at the test and control sites. Value of P < 0.01 is considered as statistically significant. Gingival index, probing pocket depth, and clinical attachment level showed a statistically significant reduction after 4 weeks in both test and control sites.
Conclusion: Ozonized water subgingival irrigation is effective in improving oral hygiene, reducing gingival inflammation, decreasing pocket depth, and increasing attachment levels when used as an adjunct to SRP in patients with chronic periodontitis.

Keywords: Chlorhexidine, ozonated water, Porphyromonas gingivalis, subgingival irrigation


How to cite this article:
Soorgani N, Agrawal R, Khashu H, Yada S, Saxena S, Prasad L. Efficacy of ozone therapy as an adjunct to scaling and root planing: A clinical and microbiological study. Int J Prev Clin Dent Res 2019;6:14-6

How to cite this URL:
Soorgani N, Agrawal R, Khashu H, Yada S, Saxena S, Prasad L. Efficacy of ozone therapy as an adjunct to scaling and root planing: A clinical and microbiological study. Int J Prev Clin Dent Res [serial online] 2019 [cited 2019 Nov 17];6:14-6. Available from: http://www.ijpcdr.org/text.asp?2019/6/1/14/263460




  Introduction Top


Periodontitis is a multifactorial disease, of which bacterial plaque is the main etiologic agent in initiation and progression of periodontitis.[1] The removal of local factors and bacterial colonization is the objective of periodontal therapy.[2] The primary purpose of subgingival irrigation is to directly reduce pocket microflora to prevent progression of the periodontal disease. The main treatment in periodontal therapy is scaling and root planing (SRP), but due to inaccessibility into deep pockets, furcation chances of residual deposits increase, resulting in recolonization pathogenic organisms in treated areas.[3] This has led to the use of antibacterial agents as subgingival irrigants. Ozone has been proposed in dentistry due to its properties such as disinfectant and antimicrobial effects.[4] It stimulates synthesis of inflammatory cytokines.[5] It reacts with the unsaturated fatty acids of the lipid layer in cellular membranes, forming hydrogen peroxides (H2O2), which has strong bactericidal activity against pathogens in plaque biofilm. Ozonated water (0.5–4 mg/L) was found highly effective against both Gram-positive and Gram-negative bacteria.[6] This study was conducted to compare and evaluate ozonized water and 0.2% chlorhexidiene (CHX) as subgingival irrigation in the treatment of chronic periodontitis.


  Materials and Methods Top


In this study, a total of 40 sites from 20 systemically healthy patients aged 35–55 years suffering from chronic periodontitis were selected among the patients visiting the Department of Periodontics, Mansarovar Dental College, Bhopal, India. The purpose of the study was explained to the patients, and written informed consent was obtained, and ethical approval was obtained from the Institutional Ethical Committee.

Inclusion criteria

Systemically healthy individuals diagnosed with chronic periodontitis (probing pocket depth [PPD] 5–7 mm) within age group of 35–55 years were included in the study.

Exclusion criteria

Patients diagnosed with aggressive periodontitis PPD <5 mm and >7 mm, pregnant and lactating females, smokers, patients under antibiotic therapy, and patients who underwent periodontal therapy in the past 6 months were excluded from the study.

Forty sites with PPD ≥6 mm were included in the study. The test sites were subjected to ozonized water subgingival irrigation. The sites on the other half of the mouth were irrigated with 0.2% CHX solution. The clinical parameters were recorded initially and after 4 weeks. Collection of gingival crevicular fluid sample for microbiological analysis was done using endodontic paper points.

Statistical analysis

Statistical analysis was performed using inferential statistics such as the independent t-test for comparison of changes in clinical and microbiologic parameters between the test group (SRP + Ozonized water group) and the control group (SRP and CHX) in the baseline and after 4 weeks. The paired t-test was done to assess the changes within the groups at the baseline and after 4 weeks as shown in [Table 1].
Table 1: Showing significant improvement in clinical parameters (Unpaired t test, ^paired t test, *significant)

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  Results Top


Baseline values showed no statistically significant difference in any of the clinical parameters at the test and control sites. P < 0.01 is considered to be statistically significant. However, compared to the control site, test site showed more significant improvement in the gingival index, probing pocket depth, and clinical attachment gain after 4 weeks as shown in [Table 1].

Microbiological analysis shows reduction in amount of bacterial colonization for Aggregatibacter actinomycetemcomitans and Porphyromonas gingivalis after subgingival irrigation using ozonated water as shown in [Figure 1].
Figure 1: Initial bacterial (Aggregatibacter actinomycetemcomitans and Porphyromonas gingivalis) colonization and reduction in bacterial count after 1 month

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  Discussion Top


Mousquès et al.[4] concluded that after SRP, bacteria recolonize reaching baseline approximately within 42 days. Greenwell and Bissada [7] concluded that bacterial colonies recolonize within 4–8 weeks. However, when compared with baseline, there was a significant reduction in bacterial load after 4 weeks. This may be due to the improvement in the oral hygiene status of the participants. Mechanical plaque removal is the most common method used along with nonsurgical periodontal therapy. The mechanical plaque control is limited by inaccessibility to periodontal pockets. Alternatively, chemical agents have to be used as an adjunct to SRP.[8] CHX is considered as the gold standard. At lower concentration, it results in increased permeability with leakage of intracellular components. At higher concentration, it causes precipitation of bacterial cytoplasm and cell death. CHX has disadvantages such as propensity to stain teeth and restorations and toxicity for gingival fibroblasts, which can impair periodontal healing.[9] Ozone gas in contact with water generates highly reactive hydroxyl (OH−) radicals.[10],[11] The destruction of a bacterial cell is due to the increase in the membrane permeability and oxidation process. The oxidation involves direct reaction of ozone molecule in an aqueous system and its free hydroxyl (OH−) radical.[12] Both these mechanisms may be involved in the destruction of bacteria by ozone. Hence, ozone can be considered as a promising antimicrobial agent as CHX to inhibit plaque formation in vivo.

Limitations

Considering the limitations of this study in terms of its short-term duration, a 4-week analysis may be insufficient, further long-term studies are required to evaluate the long-term effects of this modality as an adjunct to mechanical instrumentation.


  Conclusion Top


CHX still remains the “gold standard.” However, from this study, we can conclude that ozonized water has a significant effect in reducing gingival inflammation, decreasing pocket depth, and increasing attachment level with no side effects such as staining or bitter taste unlike CHX. Hence, ozone therapy can also be used as subgingival irrigant in patients with chronic periodontitis, as it significantly reduces the bacterial count in periodontal pockets and prevents their recolonization.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Kishida M, Sato S, Ito K. Comparison of the effects of various periodontal rotary instruments on surface characteristics of root surface. J Oral Sci 2004;46:1-8.  Back to cited text no. 1
    
2.
Drisko CL, Cobb CM, Killoy WJ, Michalowicz BS, Pihlstrom BL, Lowenguth RA, et al. Evaluation of periodontal treatments using controlled-release tetracycline fibers: Clinical response. J Periodontol 1995;66:692-9.  Back to cited text no. 2
    
3.
Issac AV, Mathew JJ, Ambooken M, Kachappilly AJ, Pk A, Johny T, et al. Management of chronic periodontitis using subgingival irrigation of ozonized water: A clinical and microbiological study. J Clin Diagn Res 2015;9:ZC29-33.  Back to cited text no. 3
    
4.
Mousquès T, Listgarten MA, Phillips RW. Effect of scaling and root planing on the composition of the human subgingival microbial flora. J Periodontal Res 1980;15:144-51.  Back to cited text no. 4
    
5.
Arsalane K, Gosset P, Vanhee D, Voisin C, Hamid Q, Tonnel AB, et al. Ozone stimulates synthesis of inflammatory cytokines by alveolar macrophages in vitro. Am J Respir Cell Mol Biol 1995;13:60-8.  Back to cited text no. 5
    
6.
Nagayoshi M, Fukuizumi T, Kitamura C, Yano J, Terashita M, Nishihara T. Efficacy of ozone on survival and permeability of oral microorganisms. Oral Microbiol Immunol 2004;19:240-6.  Back to cited text no. 6
    
7.
Greenwell H 3rd, Bissada NF. Variations in subgingival microflora from healthy and intervention sites using probing depth and bacteriologic identification criteria. J Periodontol 1984;55:391-7.  Back to cited text no. 7
    
8.
Das S. Application of ozone therapy in dentistry. Indian J Dent Adv 2011;3:538-42.  Back to cited text no. 8
    
9.
Kunisada T, Yamada K, Oda S, Hara O. Investigation on the efficacy of povidone-iodine against antiseptic-resistant species. Dermatology 1997;195 Suppl 2:14-8.  Back to cited text no. 9
    
10.
von Ohler C, Weiger R, Decker E, Schlagenhauf U, Brecx M. The efficacy of a single pocket irrigation on subgingival microbial vitality. Clin Oral Investig 1998;2:84-90.  Back to cited text no. 10
    
11.
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;21:341-8.  Back to cited text no. 11
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12.
Ramzy MI, Gomaa HE, Mostafa MI, Zaki BM. Management of aggressive periodontitis using ozonized water. Egypt Med JNRC 2005;6:229-45.  Back to cited text no. 12
    


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