REPORT

Ozone in Caries Treatment

by Prof. Dr. med. dent. Hans-Georg Schneider Ber in ! Dec. "##$

" Ozone in Caries Treatment % series of e&'eriments sho( d e&amine )hether ozone is a so effecti*e )ith caries bacteria. % c inica y contro ed st(dy can not sett e this +(estion )ithin a short time, since the hard tooth tiss(es are bradytro'h and therefore st(dies ha*e to be ' anned and carried o(t o*er a ong 'eriod of time. -rom the microbio ogica , es'ecia y the biochemica 'oint of *ie) there are no c (es that .(stify do(bts abo(t the effecti*eness of ozone )ith caries bacteria, beca(se a bacteria ha*e se*era things in common )hich ma/e them *ery sensiti*e against ozone0 1. Bacteria are negati*e y e ectrified2 they attract the 'ositi*e y e ectrified ozone mo ec( e 3 i/e a magnet4. ". Bacteria do not ha*e cho estero to 'rotect their ce membrane. Bacteria ha*e biofi ms ser*ing as a 'rotecti*e mechanism. %s is /no)n, biofi ms de*e o' )here so id and i+(id media meet and in association )ith these biofi ms, e*ery s'ecies of bacteria finds a microbio ogica niche )here it is re ati*e y she tered. 5ntraora 6borders7 bet)een 6 i+(id 8 so id7 are0 a4. Odonti(m 9 sa i*a ' a+(e, b4. Gingi*a 8 m(cosa 9 sa i*a 3so-ca ed sa i*ary fi m4, c4. Caries decay 9 sa i*a 8 food rests, d4. :ateria 9 sa i*a, e4. Concrement 8 tartar 9 sa i*a and others The ob.ecti*e of this st(dy )as to e&amine the inf (ence of ozone on the biofi m isted (nder c4. %n 6OzonyTron7 by the com'any mymed, r(n at e*e ; 3< ;"; ''m O $4 ser*ed as ozone generator. The time of a'' ication )as 1 & =# sec. )ith the 'robe )ith a c('-sha'ed si icone ca' de*e o'ed es'ecia y for caries thera'y. Decayed teeth )ere the ra) materia . %fter e&traction they )ere '(t into a trans'ort container fi ed )ith 'hysio ogica sodi(m ch oride so (tion. The fo o)ing sam' es )ere ta/en by means of a stee dri 3diameter 1.> mm 8 #.#?; in4 and diamond se'arating discs0 Gro(' 10 Decayed tooth materia from dri ing 3so-ca ed s)arf4 Gro(' "0 Tooth segments )ith non-treated caries media or 'rof(nda Gro(' $0 Tooth segments, 're'ared to the bottom of the softened area Gro(' =0 Tooth segments, 're'ared beyond the softened area into the disco o(red, hard dentine

$ %fter ha*ing been treated, a sam' es )here stored se'arate y in steri e isotonic sodi(m ch oride so (tion for in.ection in an inc(bator for "= hrs at $;@ Ce si(s 8 >;@ -ahrenheit, then sha/en and 'o(red into a Petri dish )ith Co (mbia %gar 3b ood agar )ith ;A shee' b ood4. -ina y, the bacteria s(s'ension )as s'read e+(a y on the gro)th medi(m. 5nc(bation )as carried o(t for 1## ho(rs at $;@ C 8 >;@ -. Doc(mentation )as carried o(t ta/ing 'hotogra'hs )ith a digita camera )ith constant zoom factor 3factor 114 and constant distance bet)een camera and ob.ect )ith a shine-thro(gh ight so(rce. B sam' es )ere (sed in each gro('. The i (strations are arranged in 'airs according to the order mentioned abo*e, so that the sam' e that had not been treated )ith ozone is sho)n on the eft hand side and the sam' e that had been treated )ith ozone is sho)n on the right-hand side. 5nter'retation of the res( ts0 5 (strations (nder 1 Decayed dentine s' inters are com' ete y germ-free after ozone treatment. The first 3 eft4 'hotogra'h i (strates the germ and f(ng(s 'o'( ation of the %gar dish. The Co (mbia %gar dish )hich does not sho) any sign of 'o'( ation is dis' ayed on the right-hand side. 5 (strations (nder " 5n the case of the non-treated, decayed tooth materia , there is no remar/ab e difference bet)een the treated and the non-treated sam' e 3com'are the 'hotogra'hs on the eft hand side )ith the 'hotogra'h on the right-hand side4 5 (strations (nder $ %fter 're'aration of the caries to the bottom of the softened area, i.e. )ith a *ery thin, softened decayed ayer remaining, the n(mber of germs or f(ngi is red(ced ! as )e in the sam' e that had not been treated )ith ozone as in the sam' e that had been treated )ith ozone. B(t the red(ction d(e to ozone a'' ication is higher than )ith sim' e remo*a of cario(s dentine. 5 (strations (nder = Pre'aration to the hard, disco o(red dentine res( ts in a strong dimin(tion of germs d(e to the 're'aration 3cf. eft 'ict(re4. Cith additiona ozone treatment, a so the remaining germs are remo*ed cf. right 'ict(re4. The accessibi ity of the cario(s s(bstrate to ozone 'robab y ' ays an im'ortant ro e. 5n the case of the dentine the gas can diff(se (nhindered to the bacteria or f(ngi, as is sho)n in the fo o)ing i (stration ;0

infected dentine non-infected

5 (stration ;0 Ozone can attac/ bacteria and f(ngi (nhindered from a sides 3sit(ation in gro(' 1 e&'erimenta materia 0 cario(s s)arf4 Chen the ozone 'enetrates into a cario(s defect, there are *ario(s diff(sion barriers )hich 're*ent the gas from getting direct contact to the bacteria in the dentine cana s. The detai s abo(t caries zones indicated in 6De&i/on der Eahnmedizin7 36Encyc o'aedia of Dentistry74 by Hoffmann-%&the m ser*ed as a 'attern for i (stration Ba. 5 (stration Bb is meant to i (strate the de'th of 're'aration 3gro('s $ 9 =4.

zone of necrosis 'enetration 3by germs4 deminera ization

ass(med 're'aration imits gro(' $ gro(' = disco o(red dentine 'ioneer germs

sc erotic dentine

so(nd dentine

secondary and tertiary dentine

dentine t(b( e )ith odontob astFs e&tension

caries zones 8 schematica y

i (stration of the methodo ogy

5 (stration Ba0 Diagram according to Hoffmann-%&the m Bb0 Brea/do)n of diff(sion barriers 3)hite arro)s4 by 're'aration before a'' ication of ozone. Gro(' $ < to the decayed, softened dentine 8 remaining ayer Gro(' = < to the disco o(red, hard dentine. Di/e that, the diff(sion barriers 'rotecting the 'ioneer germs can be bro/en do)n 3c(r*ed arro)4

B %ccording to the res( ts of this st(dy, the brea/do)n of diff(sion barriers is essentia for efficient ozone treatment. -(t(re c inica y contro ed st(dies, )hich )i be carried o(t o*er a 'eriod of $ or ; years, )i sho) to )hat e&tent s(rface caries and fiss(re caries can be treated s(ccessf( y )itho(t mechanica 're-treatment, on y )ith a'' ication of ozone and fo o)ing reminera ization. 5n any case, the res( ts of this st(dy a o) to recommend ozone for dee' disinfection of disco o(red dentine. Ho) far remaining caries can be eft, has to be c eared in f(t(re st(dies. 5t is for s(re that dentists )o( d ta/e a ris/ )ith re ying on y on the high disinfectant 'o)er of ozone and not carrying o(t mechanica or chemica treatment of the decayed teeth. The efficiency of ozone to ma/e infected root cana s germ-free *ery i/e y de'ends on )hether it )as 'ossib e to brea/ do)n the diff(sion barriers, i.e. to gain the ozone accessibi ity to the most distant bacteria by means of mechanica 're-treatment 3cana 're'aration4. G(mero(s dentists ha*e re'orted *ery good hea ing of chronic 'eriodontitis a'ica is and of tooth fist( ae after ozone treatment. Prof. Dr. H.-G. Schneider, Ber in

Degend0 5 (stration 10 Sha/en mi&t(re of dentine s' inters and isotonic sodi(m ch oride so (tion, 1## hrs inc(bation on Co (mbia %gar at $;@ C 8 >;@ -0 non-treated 8 =# sec ozone a'' ication 5 (stration "0 Caries media and 'rof(nda, mechanica y non-treated2 tooth segments, "= hrs storage in isotonic sodi(m ch oride so (tion, 1## hrs inc(bation on Co (mbia %gar at $;@ C 8 >;@ -0 non-treated 8 =# sec ozone a'' ication

5 (stration $0 Caries media and 'rof(nda, mechanica y treated to the remaining ayer of the softened area. 1## hrs inc(bation on Co (mbia %gar at $;@ C 8 >;@ -0 non-treated 8 =# sec ozone a'' ication 5 (stration =0 Caries media and 'rof(nda, mechanica y treated to the hard, disco o(red dentine. 1## hrs inc(bation on Co (mbia %gar at $;@C 8 >;@-0 non-treated 8 =# sec ozone a'' ication

? non-treated 5 (stration 1 =# sec ozone a'' ication

non-treated 5 (stration "

=# sec ozone a'' ication

non-treated 5 (stration $

=# sec ozone a'' ication

non-treated 5 (stration =

=# sec ozone a'' ication