Major clinical findings on the safety and effectiveness of ozone therapy in endodontic treatment: a concise systematic review

Abstract

Introduction: In the scenario of endodontic diseases, microorganisms, and their byproducts are the main causes of pulpal and periradicular diseases. Sodium hypochlorite (NaOCl) is the most commonly used root canal irrigant. Ozone (O3) therapy has been investigated to reduce or eliminate the microbiota load within the root canal system, improving endodontic results. Objective: It was to highlight the main clinical findings of the safety and effectiveness of ozone therapy in endodontic treatment. Methods: The PRISMA Platform systematic review rules were followed. The search was carried out from July to September 2023 in the Scopus, PubMed, Science Direct, Scielo, and Google Scholar databases. The quality of the studies was based on the GRADE instrument and the risk of bias was analyzed according to the Cochrane instrument. Results and Conclusion: A total of 87 articles were found, and 23 articles were evaluated in full and 14 were included and developed in the present systematic review study. Considering the Cochrane tool for risk of bias, the overall assessment resulted in 18 studies with a high risk of bias and 21 studies that did not meet GRADE and AMSTAR-2. Most studies did not show homogeneity in their results, with X2=47.7%<50%. It was concluded that ozone has been accumulating scientific evidence regarding its success in endodontic treatment, more specifically in the decontamination of root canals and activation of regenerative processes. Ozone therapy is a minimally invasive treatment method, without discomfort or pain. It also minimizes the patient's anxiety and stress level, as it reduces the duration of treatment. The beneficial role of ozone in treating different oral and dental conditions is still limited. There are possible side effects during intraoral application, as it can reach the upper respiratory tract.