Main findings from the use of ozone therapy alone or combined with conventional treatments in root canal treatment: a systematic review

Abstract

Introduction: The positive effects of ozone on biological properties include antimicrobial, immunostimulating, and biosynthetic impacts used in the treatment and maintenance of good oral hygiene. Ozone results in alteration in the metabolism of cells by raising the partial pressure of oxygen in tissues which improves the transporting capacity of oxygen in the blood. Ozone causes more blood supply to the ischemic zones due to surgical interventions like tooth extractions and implant placement. In this context of decontamination of root and periapical canals, ozone has emerged as an important sanitizer. Objective: It was to develop a systematic review of the literature to list the main findings of the use of ozone therapy alone or combined with conventional treatments in the treatment of root canals. Methods: The PRISMA Platform systematic review rules were followed. The search was carried out from March to June 2024 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 122 articles were found, 35 articles were evaluated in full and 11 were included and developed in the present systematic review study. Considering the Cochrane tool for risk of bias, the overall assessment resulted in 25 studies with a high risk of bias and 22 studies that did not meet GRADE and AMSTAR-2. Most studies did not show homogeneity in their results, with X²=88.5%<50%. Results and Conclusion: It is concluded that ultrasonic and sonic ozone activation resulted in less pain in patients undergoing single-session endodontics compared to no ozone treatment. Ozonated olive oil with zinc oxide and olive oil paste with zinc oxide demonstrated good clinical and radiographic success for pulpectomy of primary teeth. Furthermore, low-intensity laser and ozone therapy are useful methods for postoperative pain in vital symptomatic teeth, but they are not superior to each other.