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Year : 2023  |  Volume : 15  |  Issue : 1  |  Page : 87-91

Relevance of ozone therapy in the field of conservative dentistry and endodontics

Department of Conservative and Dentistry and Endodontics, King George's Medical University, Lucknow, Uttar Pradesh, India

Date of Submission28-Mar-2022
Date of Decision14-Oct-2022
Date of Acceptance15-Oct-2022
Date of Web Publication29-Dec-2022

Correspondence Address:
Rakesh Kumar Yadav
Department of Conservative Dentistry and Endodontics, King George's Medical University, Lucknow, Uttar Pradesh
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/jorr.jorr_11_22

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Ozone is used as a therapy to treat many diseases/infections for many decades; one of its major roles is in dentistry. Ozone therapy in dentistry is an emerging noninvasive technology that can be an alternative to many invasive dental procedures. This review article focuses on the applications of ozone in endodontics.

Keywords: Applications, conservative dentistry and endodontics, ozone

How to cite this article:
Yadav RK, Tiwari R. Relevance of ozone therapy in the field of conservative dentistry and endodontics. J Oral Res Rev 2023;15:87-91

How to cite this URL:
Yadav RK, Tiwari R. Relevance of ozone therapy in the field of conservative dentistry and endodontics. J Oral Res Rev [serial online] 2023 [cited 2023 May 31];15:87-91. Available from: https://www.jorr.org/text.asp?2023/15/1/87/365912

  Introduction Top

Oxygen molecules naturally occur in the environment and by combining three molecules of oxygen, ozone is made, which is capable of absorbing an ultraviolet photon of the light spectrum of the sun. As a result, high in the atmosphere, ozone filters the spectrum of light and protects living things from ultraviolet rays. As ozone evaporates, nascent oxygen molecules are released, creating oxygen gas.

By releasing nascent oxygen, it kills germs and fungi, inactivates viruses, and reduces hemorrhages in humans. To make medical-grade ozone, pure medical oxygen has to be used since the concentrations of oxygen in the atmosphere are unpredictable. Nitrogen comprises 71% of the atmosphere, oxygen makes up 28%, and other gases, such as ozone, are modified by height, temperature, and pollution.[1]

There are four main ways to produce ozone gas:

  1. Corona discharge system: Ozone produced in this type of system is of high concentration. In the medical/dental area, it is the most commonly utilized system.[2] An oxygen-rich environment produces electrical sparks, such as when lightning strikes or when any electrical device generates sparks. This is a common mechanism used by room air purifiers[3]
  2. Electromagnetic: This approach used copper wire looped around the inner and outer tubes of quartz glass tubes through which oxygen travels. The coils are subjected to a high-frequency voltage, resulting in an intense electromagnetic field[3]
  3. Ultraviolet system: Small amount of ozone is produced using this system. It is used for skin care, air purification, etc.[2]
  4. Cold plasma system: It is used in the filtration of air and water.[2] In a highly electrified glass cathode tube filled with a noble gas, an ionic flow is induced. Stainless steel tubes commonly encase this device. Through this tube, pure oxygen is delivered. The second electrode only serves as a ground and does not receive any direct current. By moving plasma through the tube, oxygen reforms into O3.[3]

  Contraindication of Ozone Therapy Top

It is contraindicated to use ozone therapy in the following situations: [4]

  1. Hyperthyroidism
  2. Deficiency of glucose-6-phosphate dehydrogenase (favism)
  3. Pregnancy
  4. Severe anemia patient
  5. Myasthenia gravis
  6. Hemorrhage in progress.

  Administration of Ozone Top

Due to the risk of air embolism, the Medical Ozone Society advises against direct intravenous ozone/oxygen gas injections.[5],[6]

  Ozone Gas Application Top

Oxygen is turned into ozone. The ozone is then directed to a handpiece that has a silicone cup. Silicone cups come in a variety of shapes to complement the shape and surface of different teeth. The silicone cup will be in close contact with the carious region of the tooth, preventing ozone from escaping. The silicone cup is used to direct ozone onto the teeth for a least of 10 s. The device absorbs ozone and converts it to oxygen in a silicone cup.

  Aqueous Solution of Ozone Top

The following are the ozone characteristics that are employed in this scenario:

  • Hemostatic action, mainly in situations of hemorrhages
  • Improved wound healing, metabolic process support, and oxygen delivery.

  Oils Containing Ozone Top

Plant extracts that transport pure oxygen and ozone are known as ozonated oils. A chemical reaction transforms the plant extracts into vivid oil. Ozonides are present in the final products. External application in this manner is completely safe.

Ozone biocompatibility

A study was conducted to compare the cytotoxic effects of gaseous and aqueous ozone on gingival fibroblast and human oral epithelial cells and also compared it with established antibiotics available commercially such as NaOCl – 5.25% and 2.25%, and H2 O2 – 3% Aqueous ozone had the best biocompatibility with the examined antiseptics.[7] When the L-929 fibroblasts of a mouse were exposed to ozonated water, metabolic activity was high, but when the cells were exposed to 2.5% NaOCl, it was significantly decreased.[8] The periodontal ligament cells' development was unaffected by irrigation of the avulsed teeth's root surfaces.[9] According to a different study, bacterial lipopolysaccharides (LPS) cause inflammatory reactions in odontoblastic cells. With ozonated water, LPS-induced inflammatory reactions were improved.[10]

  Applications Top

Recent innovations in dentistry have made ozone a useful tool for a variety of therapeutic purposes. The treatment of infectious disorders affecting the oral cavity may benefit from the use of ozone. When combined with other therapies including dental caries, periodontal procedures, and endodontic treatment, ozone therapy provides significant advantages.[4] In the fields of conservative dentistry and endodontics, ozone has been demonstrated to be quite effective. The following are some examples of how ozone is used in various endodontic procedures.

Prevention and remineralization of caries using ozone

To eradicate germs from carious lesions without causing pain or requiring anesthesia, ozone can be used. In a controlled manner, ozone is administered to the carious lesion, safely destroying the germs that cause caries while only requiring a few seconds of physical interaction. Ozone can eliminate microorganisms in the tooth's demineralized region in cases of early caries. Then, using a specific remineralization kit containing ionic forms of Ca2+, F-, PO4-3, and Na2+, the demineralized tooth structure can be remineralized.[11],[12]

Dental care for children and teenagers might have long-term consequences. If dental treatment is painful and unpleasant, these children will only go when they are in pain as they develop into adults. Restorative care is more difficult, more comprehensive, and has higher financial implications at this point, as all dentists know. Ozone and glass ionomers that release minerals can be quite useful in the dental care of these children. Ozone treatment for caries is easy, fast, and requires minimal setup. The loose material is removed initially, followed by a leathery base. Hand instruments can be used for this. The glass ionomer is used after the ozone has been sprayed and the lesion has been wetted with the CurOzone (CurOzone Canada Inc.,) remineralizing wash.

Endodontic treatment

Due to ozone's antibacterial and effervescent qualities, it can be utilized to sterilize root canal systems and rid them of necrotic debris. Sunflower, olive, and groundnut oils that have been ozonated are examples of ozone oils. This ozone oil irrigation is faster and more effective at sterilizing canals than traditional irrigation with sodium hypochlorite and sodium peroxide.

Traditional root canal therapy aims to establish a clear, well-formed root canal that can accommodate a requisite root filling. Multiple canals may exist, with auxiliary canals connecting them. The “apical delta” as well as the common lateral canals can both be found here. Irrigants were utilized in dentistry until recently to clean and dissolve organic waste in locations where mechanical instrumentation was not possible.[13]

Existing treatments, such as whitening, can be altered in this scenario to drastically improve the therapy quality for patients. When using a typical irrigant solution, like sodium hypochlorite, to irrigate the root canals, ozone can be added to the hypochlorite solution. The root canal system can be extensively cleaned and perhaps sterilized with this technique. Enterococcus faecalis is more prevalent and difficult to remove in cases where prior root canal therapy has failed. Ozone will eliminate this particular type of bacteria.[14] Ozone is also thought to penetrate the supporting and encircling bone tissue through the apical foramen. Ozone will help with tissue repair and regeneration.[15]

In a study by Sinha et al. in 2021[16] compared the impact of applying ozone to patients getting root canal treatment on postendodontic discomfort (single visit). One hundred and eight patients participated in the study and were divided into six groups and were given different treatments. Based on the Visual Analog Scale (VAS) score, they calculated the pain level and found that maximum reduction was observed in patients treated with ozone and passive ultrasonic activation followed and ozone + sonic activation.

Grocholewicz et al. in 2020[17] randomized control experiment showed the impact of ozone and nano-hydroxyapatite on early caries. They focused on remineralization on approximal initial caries using three ways. The result showed that ozone in combination with nano-hydroxyapatite showed better results compared to alone.

Root canal disinfection

Ajeti et al., in 2018,[18] performed a study, to treat chronic apical periodontitis and pulp necrosis by irrigating the root canal using gaseous ozone in combinations with NaOCl and CHX in different concentrations and found that the growth of aerobic and anaerobic was decreased.

æSimilarly, Prebeg et al., in 2016,[20] performed a study to assess ozone for the reduction in bacterial growth. However, the delivery of ozone was using a KP syringe. Moreover, found an 89.3% reduction in bacterial growth.

Boch et al., in 2015,[21] evaluated the efficacy of different root canal disinfectant agents against bacteria and found the highest in NaOCl (99.8%), NaOCl + ozone (99.95%) followed by Ethylenediamine tetra acetic acid (EDTA) + ozone (91.33%), ozone (85.38%), and EDTA alone (80.64%).


A rapid and effective reduction of root discomfort was observed following a 60-s ozone spray and repeated mineral washing of the exposed dentin.

This type of dentin desensitization lasts a little longer. Ionic fluorine and calcium are unable to reach the deepest part of the dentinal tubules due to the smear layer that covers the exposed root surface. The dentinal tubules are opened up and their diameter is enlarged once the smear layer is removed. Calcium and fluoride ions then flow heavily and effectively into the tubules, filling them, and preventing fluid exchange. Ozone can therefore quickly and effectively resolve the underlying sensitivity issue, producing outcomes that outperform those attained through conventional techniques.

Comparing the effects of ozonated oil with and without the addition of a desensitizing agent made of arginine, Veena et al., in 2020,[22] discovered that the two together had a synergistic effect on the occlusion of dentinal tubules when compared to either one separately. A study by Lena and Marianne, in 2017,[23] showed a significant reduction in pain perception of patients having dentinal hypersensitivity and were treated with ozone for 12 s.


Discoloration of the crown is a serious esthetic issue in root canal-treated teeth, particularly in the anterior teeth. Walking bleaching takes a lot of time and the results are not always good. In addition, it is not always a great idea to cover the teeth with a ceramic crown. However, all of these questions may now be answered by ozone. The channel is tightly sealed at the point where the cement and enamel meet after the root canal filler material has been taken out of the pulp chamber. The dentinal tubules are visible after the chamber has been cleaned with a solution of sodium peroxide to get rid of any type of debris, smear layer, and cement shards. At this point, glass-ionomer cement (GIC) is used to close the entrance and fill the chamber with bleaching paste or a wet cotton pellet. The crown of the tooth is exposed to ozone for at least 3–4 min following the application of the bleaching agent to the inside of the tooth. The patient receives a whiter, healthier grin after just a few minutes of this ozone therapy.[13]

Large cavitation restoration in conjunction with traditional conservative measures

Larger lesions should not be treated only with ozone; in most cases, a mix of normal therapy and ozone is required. As previously stated, the goal is to allow natural remineralization to occur in a predictable manner while minimizing tooth tissue loss. If the lesion penetrates deeply into the dentin, ozone treatment will take longer or may require numerous treatment sessions. Every time, the procedure is the same, soft debris and any unsupported enamel are scraped away. Denatured dentin is removed as much as feasible from the leathery layer. Ozone is administered for at least 40 s. Some dentists take 2–3 min to treat huge, deep lesions that almost reach the pulp chamber on an X-ray. You will then apply the remineralizing wash. Heal ozone practitioners have two alternatives at this point in the therapeutic process:

  1. Modified oral hygiene instructions are given to the patient, and the lesion is left for self-cleaning. They are instructed to apply a tiny amount of the paste straight into the cavity after brushing and rinsing as usual
  2. A resin-bonded composite or a glass ionomer that releases minerals, like Fuji VII, is used to repair the lesion. As a result, demineralization is possible without worrying about food particles colonizing the cavity again. It is critical to emphasize the importance of managing patient expectations.[24]

Treatment of avulsed teeth

Ozonated water has also been demonstrated to be effective on root surfaces following additional oral rinse for the disinfection of avulsed teeth.[25]

Role of ozone in human dental pulp stem cells (hDSCs) proliferation and differentiation

A study conducted by Pasalkar et al., in 2022, showed the proliferation and differentiation of hDSCs by allowing the culture media to absorb gaseous ozone with different concentrations. Maximum metabolic activity was observed in 10 μg/ml of ozone culture media. . It slightly increased proliferation and more differentiation while a decrease in adipose differentiation was observed in 10 μg/ml ozone supplied culture media.[26]

Temporomandibular joint (TMJ) disorders

Talking, chewing, and other essential everyday tasks are frequently restricted by TMJ disorders (TMJs), which have significant levels of pain-related impairment. Doğan et al. examined the effectiveness of ozone therapy with pharmacological treatment in individuals with extremely painful TMJ, they discovered that ozone therapy was superior to drugs.[27]

Crack tooth syndrome

After the fracture has been thoroughly investigated, decide on the prognosis, expose the tooth to ozone for 60–120 s, and then seal it with an interim restoration like GIC. The tooth must be checked and fixed on occasion.[28]

  Ozone Toxicity Top

The lungs and other organs can be harmed by inhaling ozone. Ozone therapy problems are extremely rare at 0.0007 per application. These are some of the most well-known adverse effects given in [Figure 1]. Cure for ozone intoxication includes treatment with Vitamin E and n-acetylcysteine while the patient is in the supine posture.[5]
Figure 1: Adverse effects of ozone toxicity

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The advantages and disadvantages of ozone are mentioned in [Figure 2].
Figure 2: Advantages and disadvantages of ozone

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  Conclusion Top

Ozone treatment differs from existing commercial treatment modalities in that it is a nonsurgical and conservative approach, as well as a very affordable, painless therapy that enhances patient acceptance and compliance with little side effects. Therefore, additional research is needed to support the use of ozone in dentistry on a regular basis.

Financial support and sponsorship


Conflicts of interest

There are no conflicts of interest.

  References Top

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Arifulla S, Jagadish S, Keshava Prasad BS. An overview of ozone and its utility in conservative dentistry and endodontics. J Endod 2007;19:39-47.  Back to cited text no. 3
Nogales CG. Ozone Therapy: Medical and Dentistry Application [Dissertation]. São Paulo (Brazil): University of São Paulo; 2006.  Back to cited text no. 4
Meenakshi PS, Rajasekar A. A review on ozone therapy in periodontitis. Bioinformation 2022;18:634-9.  Back to cited text no. 5
Pattanaik B, Jetwa D, Pattanaik S, Manglekar S, Naitam DN, Dani A. Ozone therapy in dentistry: A literature review. J Interdiscip Dentistry 2011;1:87-92.  Back to cited text no. 6
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Nagayoshi M, Kitamura C, Fukuizumi T, Nishihara T, Terashita M. Antimicrobial effect of ozonated water on bacteria invading dentinal tubules. J Endod 2004;30:778-81.  Back to cited text no. 8
Ebensberger U, Pohl Y, Filippi A. PCNA-expression of cementoblasts and fibroblasts on the root surface after extraoral rinsing for decontamination. Dent Traumatol 2002;18:262-6.  Back to cited text no. 9
Noguchi F, Kitamura C, Nagayoshi M, Chen KK, Terashita M, Nishihara T. Ozonated water improves lipopolysaccharide-induced responses of an odontoblast-like cell line. J Endod 2009;35:668-72.  Back to cited text no. 10
Rickard GD, Richardson R, Johnson T, McColl D, Hooper L. Ozone therapy for the treatment of dental caries. Cochrane Database Syst Rev 2004;(3):CD004153.  Back to cited text no. 11
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Maiya A. Applications of ozone in dentistry. Int J Clin Dent Sci 2011;2:23-7.  Back to cited text no. 13
Chang HH, Fulton C, Lynch E. Antimicrobial efficacy of ozone on Enterococcus faecalis. 1619 Duke St, Alexandria, VA 22314-3406 USA: Int Amer Assoc Dental Research IADR/AADR. In Journal of Dental Research 2003;82:B220.  Back to cited text no. 14
Bocci V. Ozone as a bioregulator. Pharmacology and toxicology of ozonetherapy today. J Biol Regul Homeost Agents 1996;10:31-53.  Back to cited text no. 15
Sinha N, Asthana G, Parmar G, Langaliya A, Shah J, Kumbhar A, et al. Evaluation of ozone therapy in endodontic treatment of teeth with necrotic pulp and apical periodontitis: A randomized clinical trial. J Endod 2021;47:1820-8.  Back to cited text no. 16
Grocholewicz K, Matkowska-Cichocka G, Makowiecki P, Droździk A, Ey-Chmielewska H, Dziewulska A, et al. Effect of nano-hydroxyapatite and ozone on approximal initial caries: A randomized clinical trial. Sci Rep 2020;10:11192.  Back to cited text no. 17
Ajeti NN, Pustina-Krasniqi T, Apostolska S. The effect of gaseous ozone in infected root canal. Open Access Maced J Med Sci 2018;6:389-96.  Back to cited text no. 18
Hubbezoglu I, Zan R, Tunc T, Sumer Z. Antibacterial efficacy of aqueous ozone in root canals infected by Enterococcus faecalis. Jundishapur J Microbiol 2014;7:e11411.  Back to cited text no. 19
Prebeg D, Katunarić M, Budimir A, Pavelić B, Šegović S, Anić I. Antimicrobial effect of ozone made by KP syringe of high-frequency ozone generator. Acta Stomatol Croat 2016;50:134-42.  Back to cited text no. 20
Boch T, Tennert C, Vach K, Al-Ahmad A, Hellwig E, Polydorou O. Effect of gaseous ozone on Enterococcus faecalis biofilm-an in vitro study. Clin Oral Investig 2016;20:1733-9.  Back to cited text no. 21
Veena HR, Afigith Mathew C, Daniel RA, Shubha P, Sreeparvathy R, Pradhan N. An in vitro analysis of the effect of adjunctive use of ozonated oil with a desensitizing agent on dentinal tubule occlusion. J Oral Biol Craniofac Res 2020;10:727-32.  Back to cited text no. 22
Lena K, Marianne K. Ozone treatment on dentin hypersensitivity surfaces – A pilot study. Open Dent J 2017;11:65-70.  Back to cited text no. 23
Homes JC. Restoration of ART and Ozone treated primary root carious lesions [abstract]. In: International Association of Dental Research. Cork, Ireland; 2013.  Back to cited text no. 24
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. 25
[PUBMED]  [Full text]  
Pasalkar L, Chavan M, Kharat A, Sanap A, Kheur S, Ramesh B. Gaseous ozone treatment augments chondrogenic and osteogenic differentiation but impairs adipogenic differentiation in human dental pulp stem cells in vitro. J Orofac Sci 2022;14:3-11.  Back to cited text no. 26
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Doğan M, Ozdemir Doğan D, Düger C, Ozdemir Kol I, Akpınar A, Mutaf B, et al. Effects of high-frequency bio-oxidative ozone therapy in temporomandibular disorder-related pain. Med Princ Pract 2014;23:507-10.  Back to cited text no. 27
Sabbah Fadi. Ozone Therapy in Dentistry. Medozones. Available on: https://medozons.com/ozone-therapy/different-fields/dentistry. [Last accessed on 2022 Nov 03].  Back to cited text no. 28


  [Figure 1], [Figure 2]


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