Ferhat AYRANCI, Mehmet Melih OMEZLİ, Damla TORUL, Kadircan KAHVECİ, Hasan AKPINAR

Ozonun Oral Cerrahide Kullanımı: Güncel Yaklaşımlar

Oksijenin triatomik ve kararsız bir formu olan ozon; ilkdefa Birinci Dünya Savaşı'nda gangren yaralarını tedavietmek amacıyla kullanılmıştır. 1980’li yıllardan sonrakullanımı giderek yaygınlaşan ozon terapi medikal alandabirçok hastalıkta alternatif veya tamamlayıcı tedavi seçeneğiolarak kullanılmaktadır. Günümüzde non-invaziv vedüşük maliyetli bir tedavi seçeneği olan ozon birçok farklıbiyoaktif özelliği nedeniyle sıklıkla tercih edilmektedir.Ozon uygulamaları; gaz, sıvı ve yağ olmak üzere üçfarklı formda gerçekleştirilmektedir. Ozon formlarınınkullanıldığı alanlar ve etkileri farklılık gösterebilmektedir.Genel olarak ozon terapi; immünoglobülinlerin sentezinive makrofajların etkinliğini arttırmakta, sekonder oksidanözelliği ile antimikrobiyal etkinlik göstererek immün cevabındüzenlenmesinde aktif rol oynamaktadır. Ozon terapiayrıca kan bileşenlerine etkisi sayesinde mikrosirkülasyonuarttırmaktadır. Protein sentezine katkı sağlaması ve büyümefaktörlerini arttırması ile biyosentez üzerinde pozitif etkileribulunan ozonun analjezik etkisi de bulunmaktadır. Ozonunmedikal alanda kullanıldığında görülen etkileri nedeniyle dişhekimliğinde birçok alanda kullanımı giderek artmıştır. Ağızortamının bakteri içeriği yönünden zengin olması, oral cerrahigirişimlerinden sonra enflamatuar yanıtın sık görülmesi verejeneratif tedavi protokollerinin yaygınlaşması nedeniyleozon; oral cerrahi prosedürlerinde tercih edilen yardımcı birtedavi seçeneği haline gelmiştir. Bu derlemenin amacı ozonterapinin özellikleri, etki mekanizması ve tıp, diş hekimliğive özellikle oral cerrahi alanında kullanımını literatür ışığındadeğerlendirmektir.

Use of Ozone in Oral Surgery: Current Approaches

Ozone, a triatomic and unstable form of oxygen; first used in World War I to treat gangrene wounds. Since 1980s, ozone therapy has been used as an alternative or complementary treatment for many diseases in the medical field. Today, ozone is a non-invasive and cost-effective treatment option; due to its many different bioactive features. Ozone applications can be performed in three different forms as gas, liquid and oil. Different forms of ozone can apply different areas and has different effects. Ozone therapy in general; increases the synthesis of immunoglobulins and the activity of macrophages, and plays an active role in the regulation of immune response by showing antimicrobial activity with secondary oxidant properties. Ozone also increases the microcirculation due to its effect on blood components. Ozone, which has positive effects on biosynthesis by contributing to protein synthesis and increasing growth factors, also has analgesic effect. Because of the effects of ozone that seen in medical field, the usage of ozone gradually increased in many fields of dentistry. Ozone has become a preferred adjunctive treatment in oral surgery procedures due to the fact that the oral environment is rich in bacterial content, inflammatory response is common after oral surgery and regenerative treatment protocols become widespread. The aim of this review is to evaluate the properties, mechanism of action and use of ozone therapy in medicine, dentistry and especially oral surgery in the light of the literature.

___

1. Boztaş G, Ömürlü H. Restoratif diş hekimliğinde ozon tedavileri. J Dent Fac Atatürk Uni 2014; 24(3).
2. Özler M, Öter Ş, Korkmaz A. Ozon gazının tıbbi amaçlı kullanılması. TAF Prev Med Bull. 2009; 8(1).
3. Eroglu ZT, Kurtis B, Altug HA, Sahin S, Tuter G, Baris E. Effect of topical ozonetherapy on gingival wound healing in pigs: histological and immuno-histochemical analysis. J Appl Oral Sci. 2019; 27.
4. Seidler V, Linetskiy I, Hubálková H, Stankova H, Smucler R, Mazánek J. Ozone and its usage in general medicine and dentistry. A review article. Prague Med Rep. 2008; 109(1): 5-13.
5. Pietrocola G, Ceci M, Preda F, Poggio C, Colombo M. Evaluation of the antibacterial activity of a new ozonized olive oil against oral and periodontal pathogens. J Clin Exp Dent. 2018; 10(11): e1103.
6. Seydanur Dengizek E, Serkan D, Abubekir E, Aysun Bay K, Onder O, Arife C. Evaluating clinical and laboratory effects of ozone in non-surgical periodontal treatment: a randomized controlled trial. J Appl Oral Sci. 2019; 27: e20180108.
7. Arita M, Nagayoshi M, Fukuizumi T, Okinaga T, Masumi S, Morikawa M, et al. Microbicidal efficacy of ozonated water against Candida albicans adhering to acrylic denture plates. Oral Microbiol Immunol. 2005; 20(4): 206-10.
8. Isler SC, Unsal B, Soysal F, Ozcan G, Peker E, Karaca IR. The effects of ozone therapy as an adjunct to the surgical treatment of peri-implantitis. J Periodontal Implant Sci. 2018; 48(3): 136-51.
9. El Hadary AA, Yassin HH, Mekhemer ST, Holmes JC, Grootveld M. Evaluation of the effect of ozonated plant oils on the quality of osseointegration of dental implants under the influence of cyclosporin a: an in vivo study. J Oral Implantol. 2011; 37(2): 247-57.
10. Braslavsky SE, Rubin MB. The history of ozone. Part VIII. Photochemical formation of ozone. Photochemical & photobiological sciences : Photochem. Photobiol. Sci.. 2011; 10(10): 1515-20.
11. Celakil T, Muric A, Gokcen Roehlig B, Evlioglu G, Keskin H. Effect of high‐frequency bio‐oxidative ozone therapy for masticatory muscle pain: a double‐blind randomised clinical trial. J Oral Rehabil. 2017; 44(6): 442-51.
12. Azarpazhooh A, Limeback H. The application of ozone in dentistry: a systematic review of literature. J Dent. 2008; 36(2): 104-16.
13. Al-Omiri MK, Alhijawi M, AlZarea BK, Ra’ed S, Lynch E. Ozone treatment of recurrent aphthous stomatitis: a double blinded study. Sci Rep. 2016; 6: 27772.
14. Celakil T, Muric A, Gökcen Roehlig B, Evlioglu G. Management of pain in Tmd patients: Bio-oxidative ozone therapy versus occlusal splints. Cranio. 2019; 37(2): 85-93.
15. Mostafa B, Zakaria M. Evaluation of Combined Topical Ozone and Steroid Therapy in Management of Oral Lichen Planus. Maced J Med Sci. 2018; 6(5): 879-84.
16. Yazar H, Peker E, Karaca Ir. Ozon tedavisi ve diş hekimliğindeki kullanim alanlari. J Dent Fac Atatürk Uni. 2015; 25(1).
17. Mohammadi Z, Shalavi S, Soltani MK, Asgary S. A review of the properties and applications of ozone in endodontics: an update. Iran Endod J. 2013; 8(2): 40.
18. Sivalingam VP, Panneerselvam E, Raja KV, Gopi G. Does topical ozone therapy improve patient comfort after surgical removal of impacted mandibular third molar? A randomized controlled trial. J Oral Maxillofac Surg 2017; 75(1): 51. e1-. e9.
19. Reddy S, Reddy N, Dinapadu S, Reddy M, Pasari S. Role of ozone therapy in minimal intervention dentistry and endodontics-a review. J Int Oral Health. 2013; 5(3): 102.
20. Batinjan G, Zore IF, Vuletić M, Rupić I. The use of ozone in the prevention of osteoradionecrosis of the jaw. Saudi Med J. 2014; 35(10): 1260.
21. Alan H, Vardi N, Özgür C, Hüseyin A, Yolcu Ü, Dogan DO. Comparison of the effects of low-level laser therapy and ozone therapy on bone healing. J Craniofac Surg. 2015; 26(5): e396-e400.
22. Ozdemir H, Toker H, Balcı H, Ozer H. Effect of ozone therapy on autogenous bone graft healing in calvarial defects: a histologic and histometric study in rats. J Periodontal Res. . 2013; 48(6): 722-6.
23. Polydorou O, Halili A, Wittmer A, Pelz K, Hahn P. The antibacterial effect of gas ozone after 2 months of in vitro evaluation. Clin Oral Investig. . 2012; 16(2): 545-50.
24. McKenna DF, Borzabadi-Farahani A, Lynch E. The effect of subgingival ozone and/or hydrogen peroxide on the development of peri-implant mucositis: a double-blind randomized controlled trial. Int J Oral Maxillofac Implants.. 2013; 28(6): 1483-9.
25. Hikal W, Basma Z, Sabry H. Evaluation of ozone application in dental unit water lines contaminated with pathogenic acanthamoeba. Iran J Parasitol. 2015; 10(3): 410.
26. Kazancioglu H, Kurklu E, Ezirganli S. Effects of ozone therapy on pain, swelling, and trismus following third molar surgery. Int J Oral Maxillofac Surg. 2014; 43(5): 644-8.
27. Kim K, Brar P, Jakubowski J, Kaltman S, Lopez E. The use of corticosteroids and nonsteroidal antiinflammatory medication for the management of pain and inflammation after third molar surgery: a review of the literature. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2009; 107(5): 630- 40.
28. Çebi AT. Evaluation of alveolitis cases observed after tooth extraction. SDU Sağ. Bil. Derg. 2016; 6: 6.
29. Rozanis J, Schofield I, Warren B. Is dry socket preventable? Dent J. 1977; 43(5): 233.
30. Ahmedi J, Ahmedi E, Sejfija O, Agani Z, Hamiti V. Efficiency of gaseous ozone in reducing the development of dry socket following surgical third molar extraction. Eur J Dent. 2016; 10(3): 381.
31. Oh KC, Cha JK, Kim CS, Choi SH, Chai JK, Jung UW. The influence of perforating the autogenous block bone and the recipient bed in dogs. Part I: a radiographic analysis. Clin Oral Implants Res. 2011; 22(11): 1298-302.
32. Nagata MJ, Santinoni CS, Pola NM, De Campos N, Messora MR, Bomfim SR, et al. Bone marrow aspirate combined with low-level laser therapy: a new therapeutic approach to enhance bone healing. J Photochem Photobiol B. 2013; 121: 6-14.
33. Matys J, Jaszczak E, Flieger R, Kostrzewska-Kaminiarz K, Grzech-Leśniak K, Dominiak M. Effect of ozone and diode laser (635 nm) in reducing orthodontic pain in the maxillary arch a randomized clinical controlled trial. Lasers Med Sci. 2019:1-10.
34. Kazancioglu HO, Ezirganli S, Aydin MS. Effects of laser and ozone therapies on bone healing in the calvarial defects. J Craniofac Surg. 2013; 24(6): 2141-6.
35. Erdemci F, Gunaydin Y, Sencimen M, Bassorgun I, Ozler M, Oter S, et al. Histomorphometric evaluation of the effect of systemic and topical ozone on alveolar bone healing following tooth extraction in rats. Int J Oral Maxillofac Surg. 2014; 43(6): 777-83.
36. Huth KC, Jakob FM, Saugel B, Cappello C, Paschos E, Hollweck R, et al. Effect of ozone on oral cells compared with established antimicrobials. Eur J Oral Sci. 2006; 114(5): 435- 40.
37. Thomas GW, Rael LT, Bar-Or R, Shimonkevitz R, Mains CW, Slone DS, et al. Mechanisms of delayed wound healing by commonly used antiseptics. J Trauma. 2009; 66(1): 82-91.
38. Frascino AV, Mantesso A, Corrêa L, Deboni MCZ. Aqueous-ozone irrigation of bone monocortical wounds in hyperglycemic rats. Acta Cir Bras. 2013;28(5): 327-33.
39. Renton T. Prevention of iatrogenic inferior alveolar nerve injuries in relation to dental procedures. Dent Update. 2010; 37(6): 350-63.
40. Sirin Y, Soley S. Bilateral sagittal split osteotomi ve distraksiyon osteogenezi yontemleri ile yapilan alt cenenin ilerletilmesi girisimlerinde olusan inferior alveolar sinir hasarlarinin incelenmesi. Istanbul Dis Hek Fak Derg. 2012; 46(1): 71.
41. Yucesoy T, Kutuk N, Canpolat DG, Alkan A. Comparison of Ozone and Photo-Biomodulation Therapies on Mental Nerve Injury in Rats. Journal of oral and maxillofacial surgery : J Oral Maxillofac Surg. 2017; 75(11): 2323-32.
42. Meitner SW, Bowen WH, Haidaris CG. Oral and esophageal Candida albicans infection in hyposalivatory rats. Infect Immun. 1990; 58(7): 2228-36.
43. Amin LE. Biological assessment of ozone therapy on experimental oral candidiasis in immunosuppressed rats. Biochem Biophys Rep. 2018; 15: 57-60.
44. Jacobson AS, Buchbinder D, Hu K, Urken ML. Paradigm shifts in the management of osteoradionecrosis of the mandible. Oral oncol. 2010; 46(11): 795-801.
45. Lyons A, Ghazali N. Osteoradionecrosis of the jaws: current understanding of its pathophysiology and treatment. Br J Oral Maxillofac Surg. 2008; 46(8): 653-60.
46. Öztürk Dn, Karaca Ir. Çenelerde görülen osteomiyelit. J Dent Fac Atatürk Uni. 2016; 164-9.
47. Ruggerio S, Dodson T, Fantasia J, Goodday R, Aghaloo T, Mehrotra B. Medication-related osteonecrosis of the jaw– 2014 update. American association of oral and maxillofacial surgeons position paper (AAOMS) J Oral Maxilliofac Surg. 2014;72:1938-56.
48. Van den Wyngaert T. Osteonecrosis of the jaw (ONJ) might explain the increased oral surgery risk in cancer patients treated with bisphosphonates. J Evid Based Dent Pract. 2007; 7(3): 132-5.
49. Ripamonti CI, Maniezzo M, Boldini S, Pessi MA, Mariani L, Cislaghi E. Efficacy and tolerability of medical ozone gas insufflations in patients with osteonecrosis of the jaw treated with bisphosphonates-Preliminary data: Medical ozone gas insufflation in treating Onj lesions. J Bone Oncol. 2012; 1(3): 81-7.
50. Agrillo A, Sassano P, Rinna C, Priore P, Iannetti G. Ozone therapy in extractive surgery on patients treated with bisphosphonates. J Craniofac Surg. 2007; 18(5): 1068-70.
51. Silva GB, Sacono NT, Othon-Leite AF, Mendonca EF, Arantes AM, Bariani C, et al. Effect of low-level laser therapy on inflammatory mediator release during chemotherapyinduced oral mucositis: a randomized preliminary study. Lasers Med Sci. 2015; 30(1): 117-26.
52. Bayer S, Kazancioglu HO, Acar AH, Demirtas N, Kandas NO. Comparison of laser and ozone treatments on oral mucositis in an experimental model. Lasers Med Sci. 2017; 32(3): 673-7.
53. Scully C, Porter S. Oral mucosal disease: recurrent aphthous stomatitis. Br J Oral Maxillofac Surg. 2008; 46(3): 198-206.
54. Geckili O, Bektas-Kayhan K, Eren P, Bilgin T, Unur M. The efficacy of a topical gel with triester glycerol oxide in denture-related mucosal injuries. Gerodontology. 2012; 29(2): e715-20.
55. AlZarea BK. Management of denture-related traumatic ulcers using ozone. J Prosthet Dent. 2019; 121(1): 76-82.
56. Kazancioglu HO, Erisen M. Comparison of Low-Level Laser Therapy versus Ozone Therapy in the Treatment of Oral Lichen Planus. Ann Dermatol. 2015; 27(5): 485-91.
57. Scully C, Carrozzo M. Oral mucosal disease: Lichen planus. Br J Oral Maxillofac Surg. 2008; 46(1): 15-21.
58. Schwarz F, Hegewald A, John G, Sahm N, Becker J. Four-year follow-up of combined surgical therapy of advanced peri-implantitis evaluating two methods of surface decontamination. J Clin Periodontol. 2013; 40(10): 962-7.
59. Garcia-Morales JM, Tortamano-Neto P, Todescan FF, de Andrade JC, Jr., Marotti J, Zezell DM. Stability of dental implants after irradiation with an 830-nm low-level laser: a double-blind randomized clinical study. Lasers Med Sci. 2012; 27(4): 703-11.
60. Karaca IR, Ergun G, Ozturk DN. Is Low-level laser therapy and gaseous ozone application effective on osseointegration of immediately loaded implants? Niger J Clin Pract. 2018; 21(6): 703-10.
61. Alkan Ö, Çöven BO, Özçopur B, Kazancı F, Kaya Y, Aydoğan C, et al. Effects of Ozone and Prophylactic Antimicrobial Applications on Shear Bond Strength of Orthodontic Brackets. Turk J Orthod. 2017; 30(4): 101.
62. Jose P, Ramabhadran BK, Emmatty R, Paul TP. Assessment of the effect of ozonated water irrigation on gingival inflammation in patients undergoing fixed orthodontic treatment. J Indian Soc Periodontol. . 2017; 21(6):484.