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Research Article
ARTICLE IN PRESS
doi:
10.25259/JGOH_1_2021

Evaluation of ozone oil irrigation as an adjunct to SRP in the treatment of chronic periodontitis – A randomized clinical trial

Department of periodontology, New Horizon Dental College and Research Institute, Bilaspur, Chhattisgarh, India
Department of periodontology, Government Dental College, Raipur, Chhattisgarh, India
Department of Periodontology, Triveni Institute of Dental Sciences, Hospital and Research Centre, Bilaspur, Chhattisgarh, India
Department of Pedodontics, Triveni Institute of Dental Sciences, Hospital and Research Centre, Bilaspur, Chhattisgarh, India
Corresponding author: Palak Sharma, Department of Periodontology, New Horizon Dental College and Research Institute, Bilaspur, Chhattisgarh, India. mayankhoney2481@gmail.com
Licence
This is an open-access article distributed under the terms of the Creative Commons Attribution-Non Commercial-Share Alike 4.0 License, which allows others to remix, transform, and build upon the work non-commercially, as long as the author is credited and the new creations are licensed under the identical terms.

How to cite this article: Sharma P, Khiraiya N, Kareem G, Raj S, Agrawal A, Bhatnagar TK, et al. Evaluation of ozone oil irrigation as an adjunct to SRP in the treatment of chronic periodontitis – A randomized clinical trial. J Global Oral Health, doi: 10.25259/JGOH_1_2021

Abstract

Objectives:

With increasing numbers of various periodontal problems one of most frequently encountered is chronic periodontitis. Although the benchmark for treatment is always scaling and root planing, non-invasive adjuncts to SRP in the form of various irrigations have shown promising results. Ozone, one of potent oxygen scavenger, is used in this study as an adjunct to non-surgical periodontal therapy.

Materials and Methods:

A total of 60 patients with 186 sites were selected with PPD >5 mm, PI >2, GI >2. Scaling and root planing was performed meticulously and on the same day ozonated olive oil irrigation was performed and the healing of gingiva was checked by clinical parameters after 1 month.

Results:

Statistically significant reduction in PPD, plaque index has been seen at the end of period of 1 month.

Conclusion:

Use of ozonated olive oil irrigation as an adjunct to scaling and root planning showed good results in reduction of clinical parameters, in patients with chronic periodontitis.

Keywords

Local drug delivery
Ozone oil
Periodontitis

INTRODUCTION

Periodontitis is an infectious inflammatory disease characterized by progressive clinical attachment loss; recession followed by mobility and ultimately tooth loss.[1]

The aim of treating periodontitis is primarily focused on decreasing the virulent microbial overload and symptoms of inflammation, that is, pain, bleeding, and mobility.[2]

For years benchmark for treatment of periodontitis is non-surgical periodontal therapy, but clinicians are always in search of something new and less time-consuming alternatives for fastest result in patients. Sub-gingival irrigation with medicaments is still a subject of alteration in treatment of periodontitis.[1]

The versatile gas ozone, the protecting layer of atmosphere, is an excellent medicament in many medicinal fields. The tri-atomic gas constitutes mainly 99–99.5% of O2 and 0.05–0.5% of O3, respectively, for medical uses.[3] Although ozone is mainly a gas but many suspension in oil and gel, liquid forms are available for medical uses. Ozone is not only used for treating the periodontal problems but also useful in treatment of perilous osteroradionecrosis of jaw.[4]

The mechanism by which the ozone medicament works are many, such as antibiotic property, analgesic property, detoxification, and immune activation by increasing catabolic and anabolic in body.[5]

The main reason behind using ozonated olive oil is its bio-combinatorial activity with epithelial and connective tissue component of oral mucosa.[6] Ozone has been found to be beneficial antiseptic agent in many ways. Placing the toothbrush in ozonated water keeps the toothbrush sterile, it is the material of choice for sterilizing heat sensitive materials.[7] Sub-gingival irrigation of ozonated water has been supported by many authors to have more beneficiary effect than chlorhexidine, Povidone-iodine sub-gingival irrigation not only have healing effect but also alters quantity of various forms of plaque there by reduces sings of inflammation of gums.[8] This study differs from other subgingival irrigational studies because of its use of ozonated olive oil which is having high substantivity in the sub-gingival areas. This study has shown minimum side effects compared to other irrigants that caused mucosal desquamation, taste alteration and discoloration of gingiva.[9] Furthermore, its economically reasonability has make it affordable for large strata of population.

MATERIALS AND METHODS

This study is a randomized control clinical trial in which patients from Outpatient Department of periodontology of New Horizon Dental College Bilaspur Chhattisgarh were included in the study. Ethical clearance has been taken by ethical committee head of institution and written and signed informed consent were taken from the patients. Out of the selected 60 patients, a total of 186 sites were selected with PPD >5 mm, PI >2, and GI >2, were selected for study.

Ethical clearance for the study was taken from the Ethical Clearance Committee of New Horizon Dental College and Research Institute, headed by Dr. Madan.

Inclusion criteria

The following criteria were included in the study:

  • Patients above age of 30 years

  • Systemically healthy individuals

  • Clinical and radiographical evidence of patient with chronic periodontitis[10]

  • At least 4–8 sites with PPD of 5mm or more

  • Patient having at least 28 teeth in dental arch.

Exclusion criteria

The following criteria were excluded from the study:

  • Patients with systemic illness

  • Patient under use of systemic antibiotics in past 12 months

  • Pregnancy and lactation.

Methodology

The study period of total 30 days included the recording of PI, GI, PPD, at the baseline or first visit of patients, then on the same day scaling was performed and patient was recalled after 7 days for root planing along with adjunctive ozonated olive oil [Figure 1] irrigations was performed [Figure 2]. Patients were followed up after 21 days’ time period and again the recordings were re-checked for the results [Figure 3].

Figure 1:: Probing pocket depth after 1 month follow up.
Figure 2:: Ozonated olive oil irrigation.
Figure 3:: Ozonated olive oil syringe.

RESULTS

The statistical analysis was performed using statistical software SPSS ver 22.0 by applying paired t-test with P < 0.05 considered as statistical significance.

The mean comparison between probing pocket depth at the baseline and after ozonated olive oil therapy showed significant reductions showing the positive relation of using ozonated olive oil irrigation therapy [Table 1 and Graph 1].

Table 1:: Mean comparison between pre-operative and post-operative in probing depth.
Clinical variables Duration Min Max Mean SD Difference mean±SD % of Mean change P-value
Probing depth PRE OP 5.00 11.00 6.10 1.06 3.25±0.11 –53.28 0.000 Significant
POST OP 2.00 7.00 2.85 1.17

Statistical Analysis: Paired t-test. Statistically significant if P<0.05

Graph 1:: Mean comparison between pre-operative and postoperative in probing depth.

Mean PPD at baseline was 6.10 ± 1.06 and 2.85 ± 1.17 after 1 month, which was found to be significant (P = 0.000).

Mean plaque index was found to be 2.42 ± 0.50 at baseline and 1.18 ± 0.39 after 1 month’ which was found to be significant (P = 0.000).

The gingival index taken at the base line was 1.30 ± 0.46 and 1.27 ± 0.44 after 1 month which was found to be significant (P = 0.000).

DISCUSSION

Ozonated water has emerged as an important oral antibacterial agent and adjunct to periodontal therapy. In the present trial, the results show that the decrease in plaque index and gingival index was comparable in the two treatment groups. There was also improvement in the control group.

The good response to non-surgical therapy in the present study confirms the results of previous studies As root surface roughness resulting from instrumentation by manual curettes and ultrasonic scalers may influence the rate of plaque retention (33), the end point of SRP was considered as the achievement of smooth tooth surfaces on tactile sensation with a periodontal explorer (35,36).

Using medicaments in sub-gingival irrigation decreases plaque indices, but does not completely eliminate signs of inflammation (8,9). Mean PPD at baseline was 6.10 ± 1.06 and 2.85 ± 1.17 after 1 month, which was found to be significant (P = 0.000) as shown in [Table 1 and Graph 1].

Mean plaque index was found to be 2.42 ± 0.50 at baseline and 1.18 ± 0.39 after 1 month’ which was found to be significant (P = 0.000) as shown in [Table 2 and Graph 2].

Table 2:: Mean comparison between pre-operative and post-operative in plaque index.
Clinical variables Duration Min Max Mean SD Difference mean±SD % of Mean change P-value
Plaque index PRE-OP 2.00 3.00 2.42 0.50 1.24±0.11 –51.24 0.000 Significant
POST-OP 1.00 2.00 1.18 0.39

Statistical Analysis: Paired t-test. Statistically significant if P<0.05

Graph 2:: Mean comparison between pre-operative and postoperative plaque index.

The gingival index taken at the base line was 1.30 ± 0.46 and 1.27± 0.44 after 1 month which was found to be significant (P = 0.000) as shown in [Table 3 and Graph 3].

Table 3:: Mean comparison between pre-operative and post-operative in gingival index.
Clinical variables Duration Min Max Mean SD Difference mean±SD % of Mean change P-value
Gingival Index PRE-OP 1.00 2.00 1.30 0.46 0.03±0.02 –2.31 0.424 Not Significant
POST OP 1.00 2.00 1.27 0.44

Statistical Analysis: Paired t-test. Statistically significant if P<0.05

Graph 3:: Mean comparison between pre-operative and postoperative gingival index

The effectiveness of ozonated olive oil as an adjunct to SRP has been hence proved in this study. The results of the study were in accordance with various authors who investigated for ozone therapy in periodontitis. Durga et al. (2010) also found the similar reduction in GI, PI. The reduction in mean PI was 0.16 ± 0.33, GI 0.34 ± 0.38, which was similar to our study in which we found reduction of PI 1.24 ± 0.11, GI 0.03 ± 0.02, respectively.[11] Dhingra and Vandana (2011) also conducted a similar study on gingival inflammation in orthodontic patients he also found similar reductions in clinical parameters as mean PI reduction was 1.03 ± 0.14, GI 0.71 ± 0.14, and PPD 0.19 ± 0.04 which was similar to our study in which we found reduction of PI 1.24 ± 0.11, GI 0.03 ± 0.02, and PPD 3.25±0.11, respectively.[12]

Carinci et al. (2015) also found same results in reduction of clinical parameters and lesser Tannerella forsythia count compared to SRP alone the P = 0.021 which was significant.[13] Isler et al. (2018) found that ozone can be used even as adjunct to regenerative therapy for peri-implantitis and has shown significant reduction in clinical parameters. The reduction in mean PI was 0.99 ± 0.17, GI 0.016 ± 0.06, and PPD 2.75 ± 0.07 which was similar to our study, in which we found reduction of PI 1.24±0.11, GI 0.03 ± 0.02, and PPD 3.25 ± 0.11, respectively.[14]

Saeed et al. (2017) found similar results of reduction in clinical parameters and P. gingivalis count on moderate to severe chronic periodontitis patients. These results were attributed because of the scavenging action of the reactive oxygen radical in ozone oil.

While there were many authors who supported for use of ozone as adjunct to SRP for chronic periodontitis there were some studies that did not yield positive results using ozone as an adjunct.[15]

Muller et al. (2007) found that there was no significant reduction in use of ozone + SRP in clinical parameters, that is, PPD, CAL, BI, and PI also it has minimum effects on viability of bacteria.[16] Dengizek et al. (2018) also found that there were no reductions in clinical and biochemical parameters of using ozone as compared to SRP alone.[17] Oskaybas et al. (2019) had similar results he also did not found any reduction significant in clinical parameters when he used ozone as adjunct to SRP.[18]

These results can be because of the inability of the patient for compliance to follow the oral hygiene instructions and also the period of the interventional trial for which the patients were recruited.

CONCLUSION

Ozonated olive oil can be used as adjunct to scaling and root planning in moderate chronic periodontitis patients. Further studies need to be conducted with larger sample size, different concentrations of ozonated olive oil. Microbial and biochemical parameters also need to be checked with use of ozonated olive oil in chronic periodontitis.

Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

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