Ahu URAZ, Fatma Berrin ÜNSAL, Deniz ÇETİNER, Fatma SOYSAL, Sila ÇAĞRI İŞLER

The efficacy of ozone therapy on free gingival graft augmentation around dental implants

Aim: The implants exhibiting lack of keratinized mucosa (KM) may be more prone to the early stage of peri-implant infection. The aim of the present study was to evaluate topical ozone therapy on free gingival graft (FGG) healing in terms of augmenting KM around the implants during 6-month follow-up.Material and methods: Thirty patients (16 women and 14 men) with inadequate KM around their implants were randomly allocated to either the ozone group (FGG + Ozone therapy) or the control group (FGG alone). The width and thickness of KM, plaque index (PI), gingival index (GI), probing depth (PD), mucosal recession (MR) and clinical attachment level (CAL) were evaluated at baseline, 1, 3 and 6 months. During 14 days postoperatively, patient’s pain perception was analyzed by using a visual analog scale analog scale (VAS). At 14 days, quality of life was also assessed via the Oral Health Impact Profile-14 (OHIP-14).Results: No significant differences were found between ozone and control groups with respect to KM dimensions at any study follow-up periods (p>0.05). Ozone group provided significantly higher CAL and MR values at 6 months compared to baseline values. Moreover, ozone group exhibited significantly lower GI values compared to the control group at 6 months (p0.05).Conclusion: Adjunctive ozone therapy did not provide any beneficial impact on the dimension of obtained KM around the implants at 6 months. However, ozone therapy may give rise to less mucosal inflammation around the implants compared to spontaneous healing.

PDF

___

Baltacıoğlu E, Bağış B, Korkmaz FM, et al. Peri-implant plastic surgical approaches to increasing keratinized mucosa width: which to use and when? J Oral Implantol 2015;41:e73-81.
Martin W, Lewis E, Nicol A. Local risk factors for implant therapy. Int J Oral Maxillofac Implants 2009;24:28-38.
Chung DM, Oh TJ, Shotwell JL, et al. Significance of keratinized mucosa in maintenance of dental implants with different surfaces. J Periodontol 2006;77:1410-20.
Bouri A Jr, Bissada N, Al-Zahrani MS, et al. Width of keratinized gingiva and the health status of the supporting tissues around dental implants. Int J Oral Maxillofac Implants 2008;23:323-6.
Kim BS, Kim YK, Yun PY, et al. Evaluation of peri-implant tissue response according to the presence of keratinized mucosa. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2009;107:e24-8.
Thoma DS, Mühlemann S, Jung RE. Critical soft-tissue dimensions with dental implants and treatment concepts. Periodontol 2000 2014;66:106-18.
Berglundh T, Lindhe J, Ericsson I, The soft tissue barrier at implants and teeth. Clin Oral Implants Res 1991;2:81-90.
Moon IS, Berglundh T, Abrahamsson I, The barrier between the keratinized mucosa and the dental implant. An experimental study in the dog. J Clin Periodontol 1999;26:658-63.
Stiller M, Mengel R, Becher S, ET AL. Soft-tissue grafting for peri-implantitis-a treatment option in case of unsuitable skeletal basic morphology of the alveolar bone and lack of keratinized mucosa: a retrospective clinical cohort study. Int J Implant Dent 2015;1:27.
Chung DM, Oh TJ, Shotwell JL, et al. Significance of keratinized mucosa in maintenance of dental implants with different surfaces. J Periodontol 2006;77:1410-20.
Schrott AR, Jimenez M, Hwang JW, et al. Five-year evaluation of the influence of keratinized mucosa on peri-implant soft tissue health and stability around implants supporting full-arch mandibular fixed prostheses. Clin Oral Implants Res 2009;20:1170-7.
Bouri A Jr, Bissada N, Al-Zahrani MS, et al. Width of keratinized gingiva and the health status of the supporting tissues around dental implants. Int J Oral Maxillofac Implants 2008;23:323-6.
Boynuegri D, Nemli SK, Kasko YA. Significance of keratinized mucosa around dental implants: a prospective comparative study. Clin Oral Implants Res 2013;24:928-33.
Malo P, Rigolizzo M, Nobre Md, et al. Clinical outcomes in the presence and absence of keratinized mucosa in mandibular guided implant surgeries: a pilot study with a proposal for the modification of the technique. Quintessence Int 2013;44:149-57.
Lin GH, Chan HL, Wang HL. The significance of keratinized mucosa on implant health: a systematic review. J Periodontol 2013;84:1755-67.
Brito C, Tenenbaum HC, Wong BK, et al. Is keratinized mucosa indispensable to maintain peri-implant health? A systematic review of the literature. J Biomed Mater Res B Appl Biomater 2014;102:643-50.
Sculean A, Gruber R, Bosshardt DD. Soft tissue wound healing around teeth and dental implants. J Clin Periodontol 2014;41:S6-S22.
Taşdemir Z, Alkan BA, Albayrak H. Effects of Ozone Therapy on the Early Healing Period of Deepithelialized Gingival Grafts: A Randomized Placebo-ontrolled Clinical Trial. J Periodontol 2016;87:663-71.
Ozdemir H, Toker H, Balcı H, et al. Effect of ozone therapy on autogenous bone graft healing in calvarial defects: a histologic and histometric study in rats. J Periodontal Res 2013;48:722-6.
Sagai M, Bocci V. Mechanisms of action involved in ozone therapy: Is healing induced via a mild oxidative stress? Med Gas Res 2011;20:1-29.
Huth KC, Jakob FM, Saugel B, et al. Effect of ozone on oral cells compared with established antimicrobials. Eur J Oral Sci 2006;114:435-40.
Silness J, Löe H. Periodontal disease in pregnancy II. Correlation between oral hygiene and periodontal condition. Acta Odontol Scand 1964;22:121-35.
Löe H, Silness J. Periodontal disease in pregnancy I. Prevalence and severity. Acta Odontol Scand 1963;21:533-51.
Ainamo J, Bay I. Problems and proposals for recording gingivitis and plaque. Int Dent J 1975;25:229-35.
Silva CO, Ribeiro Edel P, Sallum AW, et al. Free gingival grafts: graft shrinkage and donor-site healing in smokers and nonsmokers. J Periodontol 2010;81;692-701.
Mumcu G, Niazi S, Stewart J, et al. Oral health and related quality of life status in patients from UK and Turkey: A comparative study in Behcet’s disease. J Oral Pathol Med 2009;38:406-9.
Li MH, Bernabé E. Tooth wear and quality of life among adults in the United Kingdom. J Dent 2016;55:48-53.
Lorenzo R, García V, Orsini M, et al. Clinical efficacy of a xenogeneic collagen matrix in augmenting keratinized mucosa around implants: a randomized controlled prospective clinical trial. Clin Oral Implants Res 2012;23:316-24.
Oh SL, Masri RM, Williams DA, et al. Free gingival grafts for implants exhibiting lack of keratinized mucosa: a prospective controlled randomized clinical study. J Clin Periodontol 2017;44:195-203.
Buyukozdemir Askin S1, Berker E, Akincibay H, et al. Necessity of keratinized tissues for dental implants: a clinical, immunological, and radiographic study. Clin Implant Dent Relat Res 2015;17:1-12.
Patel PV, Kumar S, Vidya GD, et al. Cytological assessment of healing palatal donor site wounds and grafted gingival wounds after application of ozonated oil: An eighteen-month randomized controlled clinical trial. Acta Cytol 2012;56:277-84.
Akdeniz SS, Beyler E, Korkmaz Y, et al. The effects of ozone application on genotoxic damage and wound healing in bisphosphonate-applied human gingival fibroblast cells. Clin Oral Investig 2018;22:867-73.
Basegmez C, Ersanli S, Demirel K, et al. The comparison of two techniques to increase the amount of peri-implant attached mucosa: free gingival grafts versus vestibuloplasty. One-year results from a randomised controlled trial. Eur J Oral Implantol 2012;5:139-45.
Mormann W, Schaer F, Firestone AR. The relationship between success of free gingival grafts and transplant thickness. Revascularization and shrinkage–a one-year clinical study. J Periodontol 1981;52,74-80.
Ozcelik O, Seydaoglu G, Haytac CM. Diode laser for harvesting de-epithelialized palatal graft in the treatment of gingival recession defects: a randomized clinical trial. J Clin Periodontol 2016;43:63-71.
Douglas de Oliveira DW, Marques DP, Aguiar-Cantuária IC, et al. Effect of surgical defect coverage on cervical dentin hypersensitivity and quality of life. J Periodontol 2013;84:768-75.
Tonetti MS, Cortellini P, Pellegrini G, et al. Xenogenic collagen matrix or autologous connective tissue graft as adjunct to coronally advanced flaps for coverage of multiple adjacent gingival recession: Randomized trial assessing non-inferiority in root coverage and superiority in oral health-related quality of life. J Clin Periodontol 2018;45:78-88.
Keceli HG, Aylikci BU, Koseoglu S, et al. Evaluation of palatal donor site haemostasis and wound healing after freegingival graft surgery. J Clin Periodontol 2015;42:582-9.