Efficacy of Ozone as an Adjunctive Anti-microbial in the Non-surgical Treatment of Chronic and Aggressive Periodontitis- Part 2: Review Findings and Meta-analysis

Abstract

Chronic and aggressive periodontitis are known as inflammatory disorders which leads to tissue damage and bone loss. Ozone is a powerful oxidizer because of its ability to kill bacteria, fungi, inactivate viruses and it has been investigated as a potential anti-microbial in dentistry. The objectives were to compute a summary effect for the adjunctive use of ozone with scaling and root planning in the treatment of these diseases and to explore possible heterogeneity that may be present due to different ozone forms used during treatment. A detailed literature search was carried out across five databases and other sources to identify relevant studies. The effect size was the standardized mean difference (SMD) and 95% confidence interval calculated for clinical attachment level, probing depth, plaque index, bleeding on probing and gingival index. Between- study heterogeneity was assessed using the Q and I2 tests. The results of the meta-analysis carried out on all outcomes are; CAL (SMD= -0.350, CI= -0.779, 0.078, p=0.109), PPD (SMD= -0.360, CI= -0.840, 0.119, p=0.141), PI (SMD= -0.496, -0.753 -0.239, p value=0.0002*) ,GI (SMD= -0.697, CI= -1.463, 0.070, p=0.075) and BOP (SMD= -0.143, CI= -0.504, 0.218, p= 0.438). The use of ozone with SRP improved all measures compared to SRP alone. The effects however, ranged from small to moderate and were statistically non-significant except for the PI scores. Sub-group analysis based on ozone form showed that use of ozone in oil significantly reduced the probing pocket depth (SMD= -1.09, CI= -1.617, -0.566) than ozone used in water or as gas. Ozone as an adjunct to SRP is painless and non -invasive and may still find application as a disinfectant in the non-surgical treatment of chronic and aggressive periodontitis. However, it only accounted for small to moderate non-significant clinical improvement of these diseases. This review highlights the need for additional high level evidence, i.e. well-designed experimental studies to provide insight on the optimal concentration of ozone, duration and frequency of application irrespective of the method of delivery before it can be considered part of routine treatment.