The effect of ozone therapy in root canal disinfection: a systematic review

Abstract

Aim To answer the following focused question: ‘As regards microorganism load reduction for patients undergoing root canal treatment, is the use of ozone therapy comparable to conventional chemomechanical techniques using sodium hypochlorite (NaOCl)?’ Data sources A systematic review was conducted using controlled vocabulary and free‐text key words in the following databases: PubMed, Science Direct, Scopus, Web of Science and Open Grey until 2 November 2018. Additional studies were sought through hand searching of endodontic journals. Study eligibility criteria, participants and interventions The inclusion criteria comprised studies that compared microbial reduction in root canals after treatments with ozone and NaOCl in extracted mature human teeth or randomized clinical trials. Study appraisal and synthesis methods The quality assessment of included laboratory studies was performed with the following parameters: (i) sample size calculation, (ii) samples with similar dimensions, (iii) control group, (iv) standardization of procedures, (v) statistical analysis and (vi) other risk of bias. For randomized clinical trials, the qualitative analysis of the studies was performed from the bias risk assessment using the tool ‘Bias Risk Assessment of Randomized Controlled Studies’ Cochrane Handbook 5.0.2. Results The search resulted in 180 published studies. After removal of duplicate studies and full‐text analysis, eight studies were selected and seven were considered low risk of bias (seven ex vivo studies and one random clinical trial). Overall, the results demonstrated that ozone therapy provides significantly less microbial load reduction than NaOCl. As an adjunct in chemomechanical preparation, ozone was ineffective in increasing the antimicrobial effect of NaOCl. Ozone performance was strongly associated with the application protocol used: it is dose, time and bacterial strain dependent, besides the correlation with the use of complementary disinfection sources. Limitations A restricted number of randomized clinical trial was found, and the difference amongst the methodology of the studies did not allow a meta‐analysis to be performed. Conclusions and implications of key findings Although the selected studies had limitations, this review reached a satisfactory methodological and moderate evidence quality contributing to important preliminary information regarding ozone therapy. As regards load reduction of microorganisms for patients undergoing root canal treatment, ozone is not indicated neither to replace nor to complement the antimicrobial action of NaOCl.

The importance of reducing the viral load to diminish the risk of COVID-19 spread

“…It participates in the modulation of the immune system, improves the phagocytic activity of neutrophils and the function of erythrocytes. [89][90][91][92][93][94][95][96][97][98][99][100][101][102][103][104][105][106] The peroxidation produced by ozone damages the viral cell wall, alters the reproductive cycle, inhibits its growth, and interrupts the contact of the virus with the cell. It is involved in the oxidation of glycoproteins and glycolipids, blocking the enzymatic function of the virus.…”

“…The extra benefit of this gas is its prompt transformation into molecular oxygen without toxic residues. [93][94][95][96][97][98][99][100][101][102][103][104][105][106] To care for a patient or the general public, what protective equipment should be used according to the degree of contagion risk?…”

Ozonioterapia como coadjuvante na irrigação do sistema de canais radiculares

“…No entanto, uma porcentagem significativa da superfície do canal radicular permanece intocada, independentemente dos instrumentos usados para o preparo mecânico (Siqueira Jr et al 2018). Essas áreas não alcançadas podem abrigar os microrganismos dos protocolos de desinfecção do canal radicular (Gomes & Herrera 2018;Silva et al, 2020).…”

“…O hipoclorito de sódio (NaOCl) é o irrigante de canal radicular mais comumente usado em endodontia devido a sua atividade antimicrobiana eficaz com consequente redução significativa nos níveis de endotoxinas (Zehnder, 2006;Fidalgo et al, 2010;Neelakantan et al, 2019). No entanto, vários estudos demonstraram que a eliminação bacteriana completa não pode ser alcançada de forma consistente com nenhum dos protocolos de desinfecção atuais (Siqueira Jr et al, 2018;Silva et al, 2020). Tem sido demonstrado que sua eficácia depende de sua concentração, temperatura, solução de pH e condições de armazenamento.…”

“…Dentro deste contexto, esforços têm sido realizados para desenvolver novas técnicas para fornecer desinfecção adicional para o sistema de canais radiculares Silva et al, (2020), como irrigação ultrassônica passiva (PUI) Dioguardi et al, (2018), terapia fotodinâmica (PDT) Eslami et al, (2019), Dantas et al, (2020), técnicas de irrigação contínua Dioguardi et al, (2018), Silva et al, (2020) e métodos de irrigação apical de pressão positiva e negativa (Dioguardi et al 2018, Eslami et al, 2019, Silva et al, 2020. Ainda, estudos atuais têm investigados a atuação da ozonioterapia com o objetivo de aumentar a desinfecção no preparo químico mecânico de canais, assim, melhorar os resultados endodônticos (Nogales, et al, 2008;Huth et al, 2009;Farac et al, 2013;Hubbezoglu et al, 2014;Nogales et al, 2014;Sansriti et al, 2016).…”