Efficacy of Ozone as an Adjunctive Anti-microbial in the Non-surgical Treatment of Chronic and Aggressive Periodontitis- Part 2: Review Findings and Meta-analysis

Oluwatosin Tokede^1, , Yuri Jadotte² and Abrar Tounsi¹

¹Dental Public Health, School of Public Health, Rutgers University

²Quantitative Methods, Epidemiology and Biostatistics, School of Public Health and School of Nursing, Rutgers University

Cite this paper:
Oluwatosin Tokede, Yuri Jadotte and Abrar Tounsi. Efficacy of Ozone as an Adjunctive Anti-microbial in the Non-surgical Treatment of Chronic and Aggressive Periodontitis- Part 2: Review Findings and Meta-analysis. International Journal of Dental Sciences and Research. 2016; 4(2):28-34. doi: 10.12691/ijdsr-4-2-4

Abstract

Chronic and aggressive periodontitis are known as inflammatory disorders which leads to tissue damage and bone loss. Ozone is a powerful oxidizer because of its ability to kill bacteria, fungi, inactivate viruses and it has been investigated as a potential anti-microbial in dentistry. The objectives were to compute a summary effect for the adjunctive use of ozone with scaling and root planning in the treatment of these diseases and to explore possible heterogeneity that may be present due to different ozone forms used during treatment. A detailed literature search was carried out across five databases and other sources to identify relevant studies. The effect size was the standardized mean difference (SMD) and 95% confidence interval calculated for clinical attachment level, probing depth, plaque index, bleeding on probing and gingival index. Between- study heterogeneity was assessed using the Q and I² tests. The results of the meta-analysis carried out on all outcomes are; CAL (SMD= -0.350, CI= -0.779, 0.078, p=0.109), PPD (SMD= -0.360, CI= -0.840, 0.119, p=0.141), PI (SMD= -0.496, -0.753 -0.239, p value=0.0002*) ,GI (SMD= -0.697, CI= -1.463, 0.070, p=0.075) and BOP (SMD= -0.143, CI= -0.504, 0.218, p= 0.438). The use of ozone with SRP improved all measures compared to SRP alone. The effects however, ranged from small to moderate and were statistically non-significant except for the PI scores. Sub-group analysis based on ozone form showed that use of ozone in oil significantly reduced the probing pocket depth (SMD= -1.09, CI= -1.617, -0.566) than ozone used in water or as gas. Ozone as an adjunct to SRP is painless and non -invasive and may still find application as a disinfectant in the non-surgical treatment of chronic and aggressive periodontitis. However, it only accounted for small to moderate non-significant clinical improvement of these diseases. This review highlights the need for additional high level evidence, i.e. well-designed experimental studies to provide insight on the optimal concentration of ozone, duration and frequency of application irrespective of the method of delivery before it can be considered part of routine treatment.

Keywords:
Chronic periodontitis aggressive periodontitis ozone therapy scaling and root planning clinical attachment level probing pocket depth plaque index bleeding on probing gingival index adjunct meta-analysis

This work is licensed under a Creative Commons Attribution 4.0 International License. To view a copy of this license, visit http://creativecommons.org/licenses/by/4.0/

References:

[1]	Dusane, J., Mogal, V., Borse, P., Thakare, P., Kshirsagar, S. (2016). Recent trends in treatment of periodontitis. Pharmaceutical And Biological Evaluations;3(1): 19-31.
[2]	Skurska A, Pietruska MD, Paniczko-Drężek A, Dolińska E, Zelazowska-Rutkowska B, Zak J, Pietruski J, Milewski R, Wysocka J (2010). Evaluation of the influence of ozonotherapy on the clinical parameters and MMP levels in patients with chronic and aggressive periodontitis; 55(2): 297-307.
[3]	Hayakumo, S., Arakawa, S., Mano, Y. and Izumi, Y. (2013). Clinical and microbiological effects of ozone nanobubble water irrigation as an adjunct to mechanical subgingival debridement in periodontitis patients in a randomized controlled trial. Clinical Oral Investigations; 17: 379-388.
[4]	Yilmaz S, Algan S, Gursoy H, Noyan U, Kuru B. E, Kadir, T (2013). Evaluation of the clinical and antimicrobial effects of the Er:YAG laser or topical gaseous ozone as adjuncts to initial periodontal therapy. Photomed Laser Surg; 31(6): 293-298.
[5]	Al Habashneh R, Alsalman W, Khader Y (2015). Ozone as an adjunct to conventional nonsurgical therapy in chronic periodontitis: a randomized controlled clinical trial. J Periodont Res; 50: 37-43.
[6]	Patel PV, Patel A, Kumar S, Holmes JC (2012). Effect of subgingival application of topical ozonated olive oil in the treatment of chronic periodontitis: a randomized, controlled, double blind, clinical and microbiological study. Minerva Stomatol; 61(9): 381-98.
[7]	Shoukheba M.Y.M, Ali Sh. A (2014). The effects of subgingival application of ozonated olive oil gel in patient with localized aggressive periodontitis. A clinical and bacteriological study. Tanta Dental Journal; 11(1): 63-73.
[8]	Katti, S. S., Chava, V. K. (2013). Effect of Ozonised water on Chronic Periodontitis - A Clinical Study. Journal of International Oral Health JIOH; 5(5): 79-84.
[9]	Higgins JPT, Green S (2011). Cochrane Handbook for Systematic Reviews of Interventions Version 5.1.0. Available from www.cochrane-handbook.org.
[10]	Faraone, S. V. (2008). Interpreting Estimates of Treatment Effects: Implications for Managed Care. Pharmacy and Therapeutics; 33(12): 700-711.
[11]	Mani A, Shukla P, Patel R, Bhople T (2014). Ozone therapy in Periodontics- A review. Journal of Medical Science and Clinical Research. JMSCR; 2(12): 3352-3358.