ozone without borders - caries...

© Dr Julian Holmes 2011

caries management

research & clinical application


present dentistry

It is a sad fact of life that every dentist is trained

that if there is an area of decay in a tooth, the only

way to treat this is to drill the decay out or

amputate it, and then place a filling, which will

need replacement at some time in the future; at

worse, the tooth may have to be removed.


present dentistry


infection? let‟s amputate!


easy to apply + great results


dentistry can change peoples lives

1996; 11; 22 1998; 12; 10


• dull

• leathery

• shiny

• hard, remineralised

caries reversal


research in dental care

• 0 1 2 3 4

SoftHard Leathery

Progression

Reversal

0 1 2 3 4

SoftHard Leathery

ProgressionProgression

ReversalReversal


~ diagnosis & evaluation; research results

Holmes J & Lynch E, 2001 (from Lussi A, Caries Research, 1999; 33, 297)

3+ mm into dentine CSI 5> 30Visible on X-rays -> DV

1-2mm into dentine CSI 425~29? visible on X-rays -> DV

at the edj CSI 320~24stain -> DV

confined to enamel CSI 210~19white spot -> DV

extent of carious lesionDIAGNOdent Values

a basic guide to the DIAGNOdent values & The CSI

caries diagnosis


caries diagnosis

Holmes J, 2007 (from Holmes J & Lynch E, 2001)


caries diagnosis

Index Clinical Severity IndexDIAGNOdent

Reading

Clinical

CriteriaOperative Care

Treatment

(seconds)

Sessions

requiredProtocol

0

Severity Index 0.

Lesion arrested (defined as deemed to

have had infected demineralised

dentine or enamel where clinical

remineralisation of the under lying

dentine and enamel is considered to be

complete) This scenario is where

clinical remineralisation of the

underlying dentine is considered to be

complete with no infection remaining

in dentine or enamel. No frosting in

the fissure will be visible after drying.

Varies

due to stain

uptake by

remineralised

tissue

hard, shiny

surface no

frosting

open fissure,

O3 + glass

ionomer or

resin sealant

combine

ozone with air

abrasion

1 x 60-

second

ozone

cycles

Single

treatment

session

open lesion,

remove any

debris, O3,

mineral wash,

glass ionomer

or resin

sealant & OHI

1

Severity Index 1.

Lesion deemed to be reversing

(defined as deemed to have infected

demineralised dentine or enamel that

is reversing) This scenario is where

clinical remineralisation of the

underlying dentine is considered to be

in the process of remineralising the

demineralised dentine, but is not yet

complete. The frosted enamel in the

fissure (visible after drying) will be

reducing.

Varies

due to stain

uptake by

remineralised

tissue

dried lesion

appears

frosted,

white

demineralis

ation

open fissure,

O3 + glass

ionomer or

resin sealant

combine

ozone with air

abrasion

1 x 60-

second

ozone

cycles

Single

treatment

session

open lesion,

remove any

debris, O3,

mineral wash,

glass ionomer

or resin

sealant & OHI



ReadingClinical Criteria Operative Care

Treatment

(seconds)

Sessions

requiredProtocol

2

Severity Index 2.

Lesion deemed to require fissure sealant

with a preventative resin restoration

(define this as deemed to have enamel

caries confined to the enamel and NOT

extending to the amelodentinal junction)

10 - 19

dried lesion

appears frosted,

white

demineralisation

open

lesion,

remove

debris,

O3 +

glass

ionomer

combine

ozone

with air

abrasion

1 x 60-

second

ozone

cycles

Single

treatment

session

open lesion,

remove soft

debris, O3,

mineral wash,

glass ionomer or

resin sealant &

OHI

3

Severity Index 3.

Lesion deemed to require drilling and

filling with a preventative resin

restoration (define this as deemed to have

enamel caries extending to the

amelodentinal junction but not beyond

into dentine)

20 - 24

dried lesion

appears frosted,

white

demineralisation

open

lesion,

remove

debris,

O3 +

glass

ionomer

combine

ozone

with air

abrasion

1 x 60-

second

ozone

cycles

Single

treatment

session

open lesion,

remove soft

debris, O3,

mineral wash,

glass ionomer or

resin sealant &

OHI

4

Severity Index 4.


filling (define this as deemed to have

infected dentine extending less than one

millimeter into dentine)

25 - 29

dried lesion

appears frosted,

white enamel

demineralisation,

soft dentine

open

lesion,

remove

debris,

O3 +

glass

ionomer

combine

ozone

with air

abrasion

1 x 60-

second

ozone

cycles

Single

treatment

session

open lesion,

remove soft

debris, O3,

mineral wash,

glass ionomer &

OHI

5

Severity Index 5.


filling (define this as deemed to have

infected dentine extending one to two

millimeters into dentine)

25 - 29

dried lesion

appears frosted,

white enamel

demineralisation,

soft dentine,

possible pulp

exposure in

deciduous teeth

open

lesion,

remove

debris,

O3 +

glass

ionomer

combine

ozone

with

operativ

e care

2 x 60-

second

ozone

cycles

Single

treatment

session

open lesion fully,

remove soft

debris, saucerise

lesion, O3, leave

open to

remineralise, use

glass ionomers &

OHI

caries diagnosis


caries diagnosis


ReadingClinical Criteria Operative Care

Treatment

(seconds)

Sessions

requiredProtocol

6

Severity Index 6.

Lesion deemed to require drilling

and filling (define this as deemed to

have infected dentine extending two

or more millimeters into dentine)

30 - 50

dried lesion appears

frosted, white enamel

demineralisation, soft

dentine, possible pulp

exposure

multi-

appointment

& stage

treatment

protocol

combine

ozone

with

operative

care

3+ 60-

second

ozone

cycles

Multiple

treatment

sessions

open lesion

fully, remove

soft debris,

saucerise lesion,

O3, leave open

to remineralise,

use glass

ionomers & OHI

7

Severity Index 7.



have heavily infected dentine

extending over 3 millimeters into

dentine)

51 - 90




dentine, probable

pulp exposure

multi-

appointment

& stage

treatment

protocol

combine

ozone

with

operative

care

4+ 60-

second

ozone

cycles

Multiple

treatment

sessions

open lesion

fully, remove

soft debris,

saucerise lesion,

O3, leave open

to remineralise,

use glass

ionomers & OHI

8

Severity Index 8.



have heavily infected dentine

extending over 3 millimeters into

dentine)

over 90

reading is

beyond the

limits of the

DIAGNOdent




dentine, probable

pulp exposure

multi-

appointment

& stage

treatment

protocol

combine

ozone

with

operative

care

4+ 60-

second

ozone

cycles

Multiple

treatment

sessions

open lesion

fully, remove

soft debris,

saucerise lesion,

O3, leave open

to remineralise,

use glass

ionomers & OHI


early enamel caries

• enamel under acid attack

• enamel demineralises

• mineral loss leads to clinical changes

• O3 eliminates bacteria & acids

• mineral applied wash onto enamel

• fuji7 applied to enamel fissures

– long-term fluoride release

– prevents debris impaction

• remineralised enamel > resistance

• alternative to fissure sealant

– fast

– easy to apply

– predictable

ozone therapies in dental care


clinical examples – the early carious lesion


enamel demineralisation

„white spots‟


~ treatment of occlusal decay



example 1

• enamel decay

• early demineralisation

• confined to enamel/EDJ


Clinical Reversal of Occlusal Pit and Fissure Carious Lesions (OPFCLs)

Holmes J1 and Lynch E2. 1 Adentec & UKSmiles, Wokingham, Berkshire, UK2Health and Healthcare Group, School of Dentistry, Queen’s University Belfast, Northern Ireland

Introduction

Aim

Materials and Methods

Conclusions

Discussion

No

1306

Recent reports in the UK national press have lead to

an interest by the general public in ozone

technologies. This study, ‘Clinical Reversal of

Occlusal Pit and Fissure Carious Lesions (OPFCLs)

using Ozone in General Dental Practice’ was set up

to assess the effects of the use of ozone on occlusal

pit and fissure caries in a general dental practice.

The aim of this study was to observe and measure the

Clinical Reversal, Stabilisation or Progression of

Clinical Reversal of Occlusal Pit and Fissure Carious

Lesions (OPFCLs) using Ozone in a General Dental

Practice.

The data sets were obtained from 237 patients with 978

occlusal pit and fissure carious lesions (OPFCLs), who

presented to UKSmiles, a general dental practice, near London,

over a period from December 2001 through to the end of August

2002, and subsequently attended a 2-month recall.

Each tooth was randomized and assigned to two groups; a, be

treated with O3 or b, left as a control. All surfaces to be

measured were cleaned with the ProphyFlex (KaVo) and each

lesion assigned an index number using a Clinical Severity Index

(CSI) as shown in Table 1b. This Index value was recorded.

Various indices have been used in past studies, and a Clinical

Severity Index (CSI, Table 1), developed by Professor Edward

Lynch (Queens University, Belfast) & Dr Julian Holmes

(UKSmiles, Wokingham) was used to determine how long each

lesion was to be treated with ozone. This treatment time varied

from 0 seconds for the lowest (0) CSI score to 40 seconds with

the highest (5) CSI score. The CSI used in this study was based

on the Ekstrand index for clinical caries detection. The Ekstrand

Index was modified to allow easy and fast indexing of lesions in

a general dental practice environment, so that once this pilot

study is completed, other general dental practices could send in

data for an extended study using reproducible criteria.

Over 99% of the ozone treated primary occlusal fissure carious

lesions had clinically reversed based on the clinical severity index

and the DIAGNOdent readings (P<0.001). The control primary

occlusal fissure carious lesions, which had not received any ozone

treatment, did not significantly change. Patients love this system; it is

pain free, fast, and they are happy to pay for this treatment modality

The mean DIAGNOdent (DV) and CSI values are shown in Table

2. The mean DV in the O3 group decreased compared to baseline

measurements (p < 0.01) showing remineralisation. There was no

statistical difference between start DVs and finish DVf in the control

group. There were statistically significant differences in the

changes in DIAGNOdent readings between the treated lesions

after an average of 2 months, and between the O3 group / control

group at the 2-month review (p < 0.001). The table shows that the

O3 group averaged DVs reading of 65 at the start and at recall, the

O3 group had a DVf average of 16. The control group averaged DVs

reading of 63 at the start of the study period & at recall this

changed to 66. The majority of the control lesions showed little

improvement or signs of remineralisation.

Results - Statistics

The Clinical Severity Index above was the primary outcome variable.

Three Ozone treated lesions showed increased DIAGNOdent values

at the recall visit. These lesions consisted of exposed dentine which

had become darker in colour. In these lesions, it is postulated that

the remineralisation process has led to an increase in the stain or

colouration of the lesions. The DIAGNOdent is very sensitive to

stains, which is why the cleaning protocol prior to DIAGNOdent

assessment is so important. The results acquired from this ozone

study mirror those from other clinical research trials in other research

centres. By increasing the O3 Tx time up to 40 seconds, the re-

mineralisation observed has become more predictable.

Table 1; Clinical Severity Index

Table 2; DV & CSI Data

Table 3 & 4; Changes in the DV & CSI Data

References1. Baysan A., Whiley RA., Lynch E. Antimicrobial effect of a novel ozone-

generating device on micro-organisms associated with primary root carious

lesions in vitro. Caries Res. 2000; 34:498-501.

2. Baysan A., Lynch E. and Grootveld M. The use of ozone for the

management of primary root carious lesions. Quintessence Publishing Group

2001; 49-67.

3. Patients Attitudes to Managing Caries with Ozone. H.DOMINGO*, L. ABU-

NABA'A, H. AL SHORMAN, C.SMITH, R. FREEMAN and E.LYNCH. (Health

and Health Care Research Centre, School of Dentistry, Queen’s University

Belfast, Northern Ireland.) J Dent Res, 2002


Clinical Reversal of Occlusal Carious Lesions (OCLs)

Holmes J.

Health and Healthcare Group, School of Dentistry, Queen’s University Belfast, Northern Ireland

No

2752

Table 4; O3 Treatment DV & CSI

Data

Introduction

There is a great deal of interest by the general public in ozone technologies,

following press reports of this new treatment modality for tooth decay. This

study, „Clinical Reversal of Occlusal Carious Lesions (OCLs) using Ozone in

General Dental Practice‟ is based on a previous study, „Clinical Reversal of Pit

& Fissure Carious Lesions‟, published in 2002 by Holmes J et al, with

extended data.

Aim

The aim of this study was to observe and measure the Clinical Reversal,

Stabilisation or Progression of Occlusal Carious Lesions (OCLs) using Ozone

in a General Dental Practice.

Materials and Methods

The data sets were obtained from 376 patients with 2364 occlusal carious

lesions (OCLs), who presented to UKSmiles, a general dental practice, near

London, over a period from July 2001 through to the end of December 2002.

All these patients have been reviewed for a minimum of 6 months. The early

patients have now been followed for 18 months.(Table 1)

Each tooth was randomized and assigned to two groups; a, be treated with O3

or b, left as a control. All surfaces to be measured were cleaned with the

ProphyFlex (KaVo) and each lesion assigned an index number using a Clinical

Severity Index (CSI) as shown in Table 2. This Index value was recorded.

Various indices have been used in past studies, and a Clinical Severity Index

(Table 2), developed by Holmes et al, 2002 was used to determine treatment

time with o2one. This treatment time varied from 0 seconds for the lowest (0)

CSI score to 40 seconds with the highest (5) CSI score. The CSI used in this

study is based on the Ekstrand index.The CSI & DIAGNOdent (KaVo) allow

easy and fast indexing of lesions in a general dental practice environment, so

that other general dental practices can contribute data for an extended

European study using reproducible criteria.

Results – Statistics

The increased data sets have confirmed the earlier study results published in

2002, with no change in the results.

The mean DIAGNOdent (DV) and CSI values are shown in Table 3. The

mean DV in the O3 group decreased compared to baseline measurements (p <

0.01) showing remineralisation. There was no statistical difference between

start DVs and finish DVf in the control group. There were statistically

significant differences in the changes in DIAGNOdent readings between the

treated lesions after an average of 2 months, and between the O3 group /

control group at the 2-month review (p < 0.001). The table shows that the O3

group averaged DVs reading of 65 at the start and at recall, the O3 group had a

DVf average of 16. The control group averaged DVs reading of 63 at the start

of the study period & at recall this changed to 66. The majority of the control

lesions showed little improvement or signs of remineralisation.

Results – Statistics (ctd)

The CSI scores are shown in Table 4 . The majority of lesions reversed from CSI 4 to 0

in the ozone group, when compared to the control group (p < 0.001). The control group

overall showed no improvement. At the first assessment, 90% of all lesions for O3 Tx

fall into categories 3, 4 & 5, & 67% of all lesions for O3 Tx fall into CSI groups 5 & 4.

After O3 treatment, the CSI data shows 93% of the O3 Tx lesions falling into CSI 0 &

1.

There is a clear shift in the distribution of DVs, to DV f in Table 4, showing a clear

trend towards remineralisation. 61% of all lesions were assessed with a DVs of >50,

compared to a DVf at recall where 97% of all lesions had changed to a DVf of <30.

This finding is supported by earlier studies where the treatment time was limited to 10

or 20 seconds (1,2).

Discussion

The Clinical Severity Index has continued to prove a valuable assessment tool, and is

now used in dental practices which offer ozone treatment in the UK . Three Ozone

treated lesions showed increased DIAGNOdent values at the recall visit. These lesions

consisted of exposed dentine which had become darker in colour. In these lesions, it is

postulated that the remineralisation process has led to an increase in the stain or

colouration of the lesions. The DIAGNOdent is very sensitive to stains, which is why

the cleaning protocol prior to DIAGNOdent assessment is so important. The results

acquired from this ozone study mirror those from other clinical research trials in other

research centres. By increasing the O3 Tx time up to 40 seconds, the re-mineralisation

observed has become more predictable.

Conclusions

Over 99% of the ozone treated occlusal fissure carious lesions had clinically reversed

based on the clinical severity index and the DIAGNOdent readings (P<0.001). The

control primary occlusal fissure carious lesions, which had not received any ozone

treatment, did not significantly change.

Patients who are offered this treatment modality, as an alternative to conventional

amputation therapy have embraced this new technology. Research by Domingo H

(2002) has shown there is little anxiety and fear associated with this treatment method,

and it has wide application in the treatment of patients of all ages. Treatment is pain

free, fast, and patients are happy to pay for this treatment modality

ReferencesBaysan A., Whiley RA., Lynch E. Antimicrobial effect of a novel ozone-generating device on micro-

organisms associated with primary root carious lesions in vitro. J Caries Research 2000; 34:498-501.

Domingo H, Abu-Naba'a L, Al Shorman H, Smith C, Freeman R & Lynch E. Patients Attitudes to Managing

Caries with Ozone.. (Health and Health Care Research Centre, School of Dentistry, Queen‟s University

Belfast, Northern Ireland.) J Dent Res, 2002

Holmes J & Lynch E, Clinical Reversal of Pit & Fissure Carious Lesions‟ (Health and Health Care Research

Centre, School of Dentistry, Queen‟s University Belfast, Northern Ireland.) J Caries Research 2002

Table 2; CSI

Table 3; DV & CSI Data

Dr Julian Holmes, June 2003

Table 1; patient treatment/review

Recall Review Patients

Reviewed

No. lesions O3

treated

No. lesions

reversed

18 35 157 155

98.7%

12 126 586 584

99.6%

6 98 490 486

99.2%





example 1


enamel & dentine caries

• caries extends through the EDJ

• O3 eliminates bacteria & acids

• mineral applied wash onto enamel

• fuji7 applied to enamel fissures

– long-term fluoride release

– prevents debris impaction

• remineralised dentine amorphous

• alternative to tissue amputation

– fast

– easy to apply

– predictable



• Showed > 86% caries reversal at 24

months

• 10 seconds ozone applied

• BAYSAN1,2 and E. LYNCH1

• Journal of Dental Research 2001

1Restorative Dentistry and Gerodontology, Queen’s

University Belfast, Northern Ireland,

2Department of Adult Oral Health, St. Bart’s and the

Royal London School of Medicine and Dentistry,

London, UK.

research in dental careliterature overview:


Holmes J. Clinical reversal of root caries using

ozone, double-blind, randomised, controlled 18-

month trial. Gerodontology 2003; 20: 106-114.

~ to assess the efficacy of an ozone delivery system

combined with the daily use of a remineralising

toothpaste, mouthrinse and spray for the

management of non- cavitated leathery primary root

carious lesions (PRCL‟s) in an ageing patient group

(>60, mean 70.8yrs, SD+ 6).

ozone treatment of root caries objectives of this study:



results: the detail ~research in dental care

Holmes J showed that 3 months after ozone treatment (40 seconds) 69% of caries

had reversed to hard from CSI 2. Re-treatment at 3, 6, 12 and 18 months, resulted

in 100% of caries reversing to hard by the 18 month and 24 month reviews.

It is difficult to hypothesise whether all caries would have reversed to hard

without re-treatment, although Baysan et al showed that 81% of caries (CSI 1 or

2) had reversed to hard 3 months after a single 20-second ozone treatment.

0 1 2 3 4

SoftHard Leathery

Progression

Reversal

0 1 2 3 4

SoftHard Leathery

ProgressionProgression

ReversalReversal


Economic Savings Treating Root Caries with Ozone or Air AbrasionH. DOMINGO, J. HOLMES, L. ABU-NABA'A, H. AL SHORMAN, A. BAYSAN and R. FREEMAN

Queen's University of Belfast, United Kingdom

IntroductionOzone treatment has been shown to

significantly arrests root carious lesions (1-4).

However no direct time and cost comparison has

been completed comparing Ozone treatment with

conventional dental treatment methods.

AimTo assess if a new technology in a dental practice

(HealOzone 5, Fig.1) could reduce the treatment

time and cost for treatment of primary root caries

at the baseline treatment visit.

Materials and MethodsConclusionOzone, produced by the HealOzone device was

selected for a time comparison with either Air

Abrasion (Fig.2 PrepStart, Danville, USA), and a

glass ionomer filling material (Fig 3. FujiVII, GC

Corp, Japan 6), or traditional drill and fill (D&F)

procedures (using a conventional glass-ionomer

cement) for the management of primary root

caries (PRCL‟s) in an ageing patient group (>60,

mean 70.8yrs, SD 7) in a general dental practice.

A total of 68 subjects with 3 lesions each (204

PRCL‟s in total) were recruited.

Results and Discussion

The combination of modern technologies, such as

air abrasion, with Ozone offer economic savings

for dental practices and patients. Compared with

conventional drilling and filling of root caries,

Ozone treatment offers potential cost savings in

the treatment of caries.

64 subjects completed this study. There were no

observed adverse events. The mean time required

for ozone treatment was 40 seconds (SD 5

seconds) for each lesion. The mean time required

for A&F 9 minutes (540 seconds (SD 90 seconds).

The mean time required for D&F was 27 minutes

(1620 seconds (SD 8 minutes)) (overall p < 0.01).

Ozone treatment was faster than traditional D&F

by a factor of 40 and faster than A&F by 21. Air

abrasion decreased the mean time for cavity

preparation by 4 times when compared to

traditional rotary drills (67 seconds (SD 12)

compared to 4.5 minutes (SD 1.75 minutes) (p <

0.05)).

The cost* of the treatment was assessed. The

average cost to treat a lesion with ozone was

£6.90, with A&F, £13.90; and with D+F £31.10.

The potential NHS fee was assessed as £44.00.

The gross potential profit for Ozone Tx £37.10, for

AA £30.10 and D&F £13.50

*Assumes 3 lesions treated at same appointment, surgery costs

of £60.00/hour & UK NHS Fee Scale (Schedule of Fees June

2003)

The lesions were randomly assigned into three

groups; treatment with;

1.Ozone, or;

2. Air abrasion and filling (A&F), or;

3. Traditional drilling and filling (D&F).

In groups 1 & 2 PRCL preparation was carried out

without the need for local anaesthetics.

Fig.2 The PrepStart

Danville Engineering

USA

Fig.1 The HealOzone device

CurOzone Inc USA &

KaVo GmbH Germany

Fig.3 FujiVII GC

Corp

Japan

Products Used

1. Lynch E, Baysan A, Silwood C, Grootveld M. Therapeutic

oxidising activity of a novel anti-bacterial ozone-producing

device on primary root caries. Caries Res 1998; 32: 300.

2. Baysan A, Whiley R, Lynch E. Antimicrobial effects of a

novel ozone generating device on micro-organisms associated

with primary root carious lesions in-vitro. Caries Res 2000; 34:

498-501.

3. Baysan A, Lynch E. Clinical review of root caries using

ozone. J Dent Res 2002; 81: 733 (Sp Issue).

4. Holmes J. Clinical reversal of root caries using ozone,

double-blind, randomised, controlled 18-month trial.

Gerodontology 2003; 20: 106-114.

5. HealOzone, CurOzone Inc USA & KaVo GmbH Germany.

6. FujiVII, GC Corp Japan.

All lesions were finished with hand instruments

(excavators), before restoration with a glass

ionomer filling material (FujiVII). This modified

ART technique is the subject of further research.

References


At Baseline; 60 subjects, each with 2 soft PRCL‟s.

1 lesion ART+Ozone

ART, leaving pulp unexposed + 20 seconds ozone

10 (+2) minutes treatment time

1 lesion LA, & conventional “drill&fill”

11 pulp exposures requiring RCT


At Recall; 56 subjects returned for recall

All restorations scored alpha for all USPHS criteria recorded

(filling present, margins, surface finish)

additional 4 teeth required RCT

Results; 25% of conventionally treated teeth needed RCT

0% of ART + Ozone treated teeth needed RCT

Conclusion; ART + Ozone

1. reduces time

2. saves tooth tissue

3. maintains tooth vitality

4. no detrimental effect to USPHS assessment

~ research ~ Holmes J, 2004, IADR Abstract

ART – Atraumatic Restorative Care



initial presentation air abrasion preparation

combined therapies in dental care

~ enamel + dentine decay;

example 3


aa presentation after hand-instrumentation


~ enamel + dentine decay



enamel etch finished preparation



fujiVII placement 6-month assessment




initial presentation #26



example 4


after air abrasion #26



after ozone 40 seconds #26


mineral wash application #26



ready to fill #26


fujiVII application #26



occlusion re-established #26


barbara age 38

time to treat; 5 minutes


example 5




integrated treatment:

example 7




integrated treatment:


~ treatment for patients; Abigall; 7-month results


Abigall Summers

Referring Dentist Oloph Granath, USA

Before O3 Tx; 02-02-04 After O3 Tx; 28-09-04


~ treatment results to date. Charlotte


21-10-02

15-04-04

Before O3

After O3

O3 treatment started

21-10-02.

Review 15-04-04, 18-months

after the first application of O3


~ treatment for patients with secondary teeth

3 months later

Victoria Age 12

29th January 2003

Review & Assessment

05/11/2002 29/01/2003


Before O3 After O3


~ treatment for patients with secondary teeth

29/01/2003

results at 3 months


Before O3 After O3

Photographs © Dr Rob Wain, UK


• Does ozone damage dental nerve / pulp tissue?

• Chou J, Boyd D, Tompkins G. Effect of Ozone Treatment on Interleukin Levels in Dental Pulp IADR Abstract 0036, 2005

• Objective: To determine whether therapeutic levels of ozone stimulate production of the inflammatory cytokines interleukin-2 (IL-2) and interleukin-6 (IL-6) in healthy teeth.

• Conclusion: From the experiment, there was no evidence that ozone treatment stimulated an increase in the levels of IL-6 and IL-2 in healthy dental pulp.

• This suggests that ozone elicits negligible inflammatory responses (if not reduces levels of inflammation) when applied to healthy teeth, and may have potential for prophylactic treatment of patients with high caries risk.





• limitations of ozone

cannot bring life to dead tissue


• integration into routine dental care




~ ozone integrated into routine dental care

example 8


Tofflemyre matrix band

surrounds 4.5 after cavity

preparation.

Deepest caries has not been

removed, attempting to

prevent a need for root

canal treatment.

Circumference must be

sealed with block-out resin

(below) before ozone can

be delivered to kill bacteria

in the remaining carious

layer.

Photographs © Dr Melvin Perlmutter

integrated treatment:ozone therapies in dental care

example 9


~ treatment for patients with primary teeth

jade,

• age 4, 11 months

• time to treat; 4 minutes


example 10


Jake; 4 yrs old, attention disorder syndrome

pre-tx: DIAGNOdent 89, soft dentine, in pain

20 seconds O3 each tooth;

Recall & review at 46 days

post-tx: DIAGNOdent 36. hard dentine, no pain

~ treatment results to date


example 11


At Baseline; 60 subjects, each with 2 soft PRCL‟s.

1 lesion ART+Ozone

ART, leaving pulp unexposed + 20 seconds ozone


1 lesion LA, & conventional “drill&fill”

11 pulp exposures requiring RCT


At Recall; 56 subjects returned for recall

All restorations scored alpha for all USPHS criteria recorded

(filling present, margins, surface finish)

additional 4 teeth required RCT

Results; 25% of conventionally treated teeth needed RCT

0% of ART + Ozone treated teeth needed RCT

Conclusion; ART + Ozone

1. reduces time

2. saves tooth tissue

3. maintains tooth vitality

4. no detrimental effect to USPHS assessment

~ research ~ Holmes J, 2004, IADR Abstract

ART – Atraumatic Restorative Care


• ART- application

of research to other

caries presentations

• Using research to

extend the use of

technology



Darryl,

Age 3, 6 months

Time to treat; 5 minutes

#1E #2E


example 12



Beth,

Age 4, 1 month

example 13


1st Appointment. pulpotomy & GA

parents refused Tx

3rd Appointment -18 months later

glass ionomer lost, pain++

dentist has ozone - 60 seconds Tx

glass ionomer transitional fill

2nd Appointment - 6 months later

ART & glass ionomer



Beth,

Age 4, 1 month

example 13


1st Appointment – pulpotomy & GAHyper-mineralised tissue

Fuji VII

4th Appointment

Pain free

Tissue regeneration & remineralisation

Tooth vital

Space maintained for upper molar



~ enamel + dentine decay; ozone +ART

example 14


Victoria; 33. mesial decay repaired 12 years ago

~ treatment results to date. Victoria

© Dr Julian Holmes

Area of demineralisation

Ozone treated for 120 seconds, mineral wash applied


example 15


~ treatment for patients• Other patterns of decay

– treatment for failing abutments


example 16


~ treatment for patients• Other patterns of decay

– treatment for failing abutments


example 17


Masters of Progressive Care

MPDlink4.ppt

ozone without borders - caries...

Documents