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dependent on system conditions like temperature and pressure. 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.
Ozone (O3) is naturally produced by the photo dissociation of molecular oxygen (O2) into activated oxygen atoms, which then react with further oxygen molecules. This transient radical anion rapidly becomes protonated, generating hydrogen trioxide (HO3), which, in turn, decomposes to an even more powerful oxidant, the hydroxyl radical (OH).
Dr. M. Shiva Shanker
II Year Post Graduate Student ,
Dept of Periodontics, Mamata Dental College.
• Ozone generators
• Biological actions
• Routes of administration
• Ozone therapy in periodontics
• Ozone toxicity
• The word ozone is derived from the
greek “ozein” meaning odorant.
• It is an unstable gas and it quickly
gives up nascent oxygen molecule to
form oxygen gas.
• Periodontitis is a destructive
inflammatory disease of the supporting
tissues of the teeth and is caused
either by specific microorganisms or
• 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.
• In 1840, Schonbein named the substance
• it was not until 1932 that ozone was seriously
studied by the scientific community, when
ozonated water was used as a disinfectant by
Dr. E.A. Fisch, a Swiss dentist.Ozone Therapy: A New Paradigm in Periodontics, Rose Kanwaljeet
• Ozone is a triatomic molecule, Its molecular
weight is 47, 98 g/mol.
• Thermodynamically highly instable
• Medical Ozone is made when medical grade
oxygen is electrically activated (using an
Ozone Generator) to form ozone.
• Medical grade Ozone is a mixture of pure
O2 and pure O3 in the ratio of 0.1% to 5%
of O3 and 95%-99.5% of O2Ozone Therapy – A New Approach in Periodontal Management, Benita P, Volume 13,
Issue 3 Ver. I. (Mar. 2014),
• The ozone concentration may vary between
1 and 100 μg/ml (0.05-5%).
• Ozone gas has a high oxidation potential
and is 1.5 times greater than chloride when
used as an antimicrobial agent against
bacteria, viruses, fungi, and protozoa.
Ozone Therapy – A New Approach in Periodontal Management, Benita P, Volume 13,
Issue 3 Ver. I. (Mar. 2014),
How am I produced???
• UV rays
• Ozone generators
• The first ozone generator was developed by
Werner Von Siemens in Germany in 1857.
• Ultraviolet system
• Corona discharge system
• Cold plasma system
Garg R.K.,Tandon S. 2009.Ozone: A new face of dentistry. The Internet Journal of
Dental Science,7(2). DOI: 10.5580/c75
Appliances producing ozone for
• HealOzone by KaVo
• OzonyTron by MYMED Gmb H.
• Product photo (Prozone) by W&H.
Ozone: A Future in Periodontal Therapy, Dr. Chandni Adalja, Volume : 3,
Issue : 3, March 2013
• Anti –microbial action
• Anti –inflammatory & analgesic action
• Immune-stimulating action
• Anti-hypoxic action
• Bioenergetic and biosynthetic action
• Elimination of pathogens.
• Restoration of proper oxygen metabolism.
• Induction of a friendly ecologic environment.
• Increased circulation.
• Immune activation.
• Simulation of the humoral anti-oxidant
Mollica P, Harris R. Integrating oxygen/ ozone therapy into your practice. Available
from site: www.absoluteozone.com/Ozone_Article_Dentistry_ref.htm
ROUTES OF ADMINISTRATION
• Gaseous ozone
• Ozonated water
• Ozonized oil
• Activation of intracellular metabolism of oral
mucosa and dental wounds.
• Improvement of regional circulation.
• Stimulation of regenerative processes.
• Hemostasis in capillary bleedings.
• Painless procedures.
• Ozone toxicity if the level increases at
0.0007% per application.
• Not readily available
• Chronic or recurrent infections in the oral
• Sterilization of cavities, root canals,
periodontal pockets, herpetic lesions.
• Desensitization of extremely sensitive tooth
• Pre-washing of surgical sites.
• Plaque control.
• Contamination control.
• Pregnancy – to avoid mutagenic risk.
• Severe anemia
• Cardiovascular instability
• Patients on ACE inhibitors
OZONE THERAPY IN PERIODONTICS
• Ozonated water (4 mg/l) was found effective
for killing gram-positive and gram-negative
oral microorganisms and oral Candida
albicans in pure culture as well as bacteria
in plaque biofilm.
• Thanomsub et al. 2002 tested the effects of
ozone treatment on cell growth and ultra-
structural changes in bacteria (Escherichia
coli, Salmonella sp., Staphylococcus aureus
and Bacillus subtilis). It was discovered that
ozone at 0.167 mg/min/l can be used to
sterilize water, which is contaminated with
up to 105 cfu/ml bacteria within 30 min.
Destroying of bacterial cell membrane was
observed, subsequently producing
intercellular leakage and eventually causing
• Ebensberger et al. in 2002 evaluated the
effect of irrigation with ozonated water on
the proliferation of cells in the periodontal
ligament adhering to the root surfaces of 23
freshly extracted completely erupted third
• They concluded that the 2 min irrigation of
the avulsed teeth with non-isotonic ozonated
water might lead not only to a mechanical
cleansing, but also decontaminate the root
surface, with no negative effect on
• Nagayoshi et al. 2004 tested the efficacy of
ozonated water on survival and permeability
of oral micro-organisms.
• 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.
• Hems and Gulabivala, 2005 evaluated the
potential of ozone as an anti-bacterial agent
using Enterococcus faecalis as a test
• Ozone was used both gasiform (produced
by Purezone device), and aqueous (optimal
concentrations 0.68 mg/l).
• It was concluded that ozone in solutions
was antibacterial against planctonic
Enterococcus faecalis after 240 s treatment.
However it was not effective against
• Ramzy et al. in 2005 irrigated the
periodontal pockets by ozonized water in 22
patients suffering from aggressive
periodontitis. Periodontal pockets were
irrigated with 150 ml of ozonized water over
5-10 min once weekly for a clinical 4 weeks
study using a blunt tipped sterile plastic
syringe. High significant improvement
regarding pocket depth plaque index gingival
index and bacterial count was recorded
related to quadrants treated by scaling and
• 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 (chlorhexidine
digluconate [CHX]: 2%, 0.2%; sodium
hypochlorite 5.25%, 2.25%; hydrogen
peroxide-H2 O2 3%) under most conditions.
• Therefore, aqueous ozone fulfills optimal cell
biological characteristics in terms of
biocompatibility for oral application.
• 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.
• Actinomyces naeslundii, Veillonella dispar,
Fusobacterium nucleatum, Streptococcus
sobrinus, Streptococcus oralis and c. albicans
• Gasiform ozone was produced by vacuum
ozone delivery system Kavo Healozone. They
concluded that the matrix-embedded microbial
• 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
• Fillippi. A observed the influence of
ozonized water on the epithelial wound
healing process in the oral cavity. It was
found that ozonized water applied on daily
basis can accelerate the healing rate in oral
• Huth, et al. in 2011 compared the
effectiveness of ozone with that of the
established antiseptic 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 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
• 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
• 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.
• Hayakumo et al in 2012 evaluated the
clinical and microbiological effects of NBW3
irrigation as an adjunct to subgingival
debridement for periodontal treatment.
• The present study suggests that subgingival
irrigation with NBW3 may be a valuable
adjunct to periodontal treatment.
• Yilmaz 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)
• ozone has an antimicrobial effect equivalent
to that of the Er:YAG laser.
• 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
• Shoukheba et al in 2014 evaluated the
effect of subgingival application of ozonated
olive oil gel as an adjunct to scaling and
root planing (SRP) in aggressive
• The study concluded that (Oxactiv) gel
could be a promising adjunct to SRP in the
treatment of aggressive periodontitis.
• 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.
• Kl Vandana et al in 2015 assessed the
effect of chlorhexidine (CHX), povidone
iodine (PI), and ozone (OZ) on the
microorganisms in dental 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.
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
• The administration of short term
cyclosporine together with the topical
application of ozonated oil may influence
• 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
• 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.
• Ozone inhalation can be toxic to the
pulmonary system and other organs.
• Known side-effects are upper respiratory
irritation, rhinitis, cough, headache,
occasional nausea, vomiting, shortness of
breath, blood vessel swelling, poor
circulation, heart problems and epiphora.
• Patient must be placed in supine position
• Inhale humid oxygen
• Ascorbic acid
• Vitamin E
• Ozone therapy allows a new vision, which
complies with needs and demands of the
public for non-invasive, effective periodontal
care and it is truly a paradigm shift in
• Treating patients with ozone cuts off
treatment time, eliminates bacterial count
more precisely and moreover, it is
completely painless resulting increased
acceptability and compliance of the patient.
• Further research in ozone would bring a
• 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 :
• 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,
• Ozone in periodontics, natural remedy in dentistry, journal of dental
• Current concepts of oxygen ozone therapy for dentistry, john a rotchfield.
• Ozone therapy: a new paradigm in periodontis, 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 academiae mcdial, 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 inernational journal of oral and maxillofacial implants.