Table 4 Characteristics of included studies in this review
Study No. | First author | Year | Country | Title | Study type | Aim | Methods | Results and conclusion | Quality assessment |
|---|---|---|---|---|---|---|---|---|---|
1 | Rapone et al. [31] | 2022 | Italy | The gaseous ozone therapy as a promising antiseptic adjuvant of periodontal treatment: a randomized controlled clinical trial | Randomized Clinical Trial (RCT) | The evaluation of the effectiveness of gaseous ozone therapy as an adjunct to standard non-surgical periodontal therapy in promoting tissue healing responses in patients with moderate to severe generalized periodontitis | A prospective randomized study was conducted in 90 healthy subjects with a diagnosis of moderate to severe generalized periodontitis. Participants were randomly divided into two groups: Group A received scaling and root planning (SRP) combined with gaseous ozone therapy, while Group B received SRP alone | Results showed significant differences in periodontal parameters between the two groups at the 3-month mark (p ≤ 0.005). This study indicated that the combination of scaling and root planning with ozone therapy had better clinical outcomes in the treatment of periodontitis compared to standard SRP alone, suggesting that ozone therapy may enhance the therapeutic response in periodontal treatment | 18/20 |
2 | Sghaireen et al. [32] | 2020 | Saudi Arabia | Effect of aqueous ozone solution irrigation on healing after treatment with dental implants: a cross-over randomized controlled clinical trial | Randomized Clinical Trial (RCT) | The determining the effect of local irrigation with ozone (O3) water solution on soft tissue healing after dental implantation | The recruited patients underwent similar oral surgery (dental implants) on both sides of their upper jaw. Immediately after surgery and after 3 days, one site was randomly irrigated with 10 ml of O3 water solution, while the other side was irrigated with normal saline | The study revealed that O3 treatment enhanced soft tissue healing in the immediate postoperative period after dental implantation. However, the lack of a significant difference observed on day 5 suggests that further research is needed to evaluate the long-term clinical outcomes of O3 treatment | 17/20 |
3 | Sinha et al. [33] | 2021 | India | Evaluation of ozone therapy in endodontic treatment of teeth with necrotic pulp and apical periodontitis: a randomized clinical trial | Randomized Clinical Trial (RCT) | The comparison of the effects of different ozone application techniques on the prevalence of post-root canal pain in patients undergoing single-visit root canal treatment | This study included 108 patients with necrotic pulp in single-rooted teeth and apical periodontitis. Patients were randomly assigned to one of five groups. Patient discomfort level was assessed at six different time intervals using a visual analog scale (VAS) | The results showed that VAS scores for pain were highest in the control group and lowest in the NA, MDA, SA, and PUA groups. A statistically significant decrease in VAS scores was observed in the PUA and SA groups compared to the NA, control, and MDA groups. This study concluded that ultrasonic and sonic activation of ozone during a single root canal treatment resulted in less post-root canal pain compared to no ozone treatment | 14/20 |
4 | Piva et al. [34] | 2020 | Italy | The use of ozone therapy for treatment of periodontal disease: A split-mouth, randomized, controlled clinical trial | Randomized Clinical Trial (RCT) | The evaluation of the effectiveness of Ozonline® in the treatment of chronic periodontitis in adult patients | A split-mouth randomized controlled study was conducted in ten patients (5 men and 5 women, 42–73 years old, mean age 55 ± 7 years) with a diagnosis of chronic periodontitis. Microbiological samples were collected from the sites at baseline and again on day 7, for a total of 20 sites (10 sites from the left quadrant treated with Ozonline® and 10 from the right quadrant treated with ultrasonic scaling) | The results showed a significant reduction in bacterial counts in the left quadrant treated with Ozonline® compared to the right quadrant. This study demonstrated the efficacy of Ozonline® in the management of moderate to severe chronic periodontitis, suggesting that this novel treatment can improve patient outcomes by reducing bacterial load in periodontal pockets | 16/20 |
5 | Nicolini et al. [35] | 2021 | Brazil | Efficacy of ozonated water mouthwash on early plaque formation and gingival inflammation: a randomized controlled crossover clinical trial | Randomized Clinical Trial (RCT) | Evaluation of the effect of ozonated water on initial plaque formation and gingivitis | The sample consisted of 42 dental students who were divided into two experimental groups (using ozonated water mouthwash) and a control group (using double-distilled water mouthwash). The plaque-free zone index (PFZI) was used to assess initial sub gingival biofilm formation at 24, 48, 72, and 96 h | The study showed no statistically significant difference in PFZ index conversion scores between the experimental group (19.07) and the control group (19.79) at all tooth surfaces. Ozonated water had no significant effect on supra- and sub gingival biofilm formation or gingivitis | 19/20 |
6 | Shekhar et al. [36] | 2021 | India | An evaluation of the effect of ozone therapy on tissues surrounding dental implants | Randomized Clinical Trial (RCT) | The evaluation of the effect of ozone therapy on inflammation, pain, and wound healing after dental implant surgery | A clinical study was conducted with 60 systematically healthy patients who were divided into two groups: 30 patients treated with ozone (experimental group) and 30 patients who did not receive ozone treatment (control group). Clinical assessments included measurement of C-reactive protein (CRP) levels for inflammation, use of a visual analog scale (VAS) for pain assessment, and assessment of tissue wound healing with the Wound Healing Index (WHI) | The mean tissue healing indices in the experimental group on day 7 (4.23 ± 0.43) and day 14 (4.97 ± 0.18) were significantly higher (p< 0.01) compared with the control group (3.07 ± 0.45 and 4.03 ± 0.18, respectively). No adverse events were observed in either group. Ozone therapy accelerates tissue wound healing, minimizes tissue inflammation, and reduces pain after dental implant surgery | 18/20 |
7 | Schneider et al. [37] | 2023 | Brazil | Efficacy of ozonized sunflower oil with tea tree oil as desensitizing agents in dental bleaching: randomized and double-blind clinical trial | Randomized Clinical Trial (RCT) | Evaluation of the effectiveness of spearmint oil combined with tea tree oil in controlling dentin sensitivity after bleaching compared to the control group using potassium nitrate and sodium fluoride | A randomized, double-blind, double-blind clinical trial was conducted with participants divided into two experimental groups (n = 29). The control group received potassium nitrate and sodium fluoride, while the experimental group received ozonated sunflower oil combined with tea tree oil | The results showed that there was no statistically significant difference in sensitivity levels between the experimental and control groups. The study concluded that ozonized oil combined with tea tree oil was as effective as potassium nitrate and sodium fluoride in the control group in reducing tooth sensitivity induced by tooth whitening. Furthermore, neither treatment had any effect on the effect of hydrogen peroxide bleaching | 17/20 |
8 | Bin Hassan et al. [38] | 2024 | Saudi Arabia | Tooth Sensitivity Following Hydrogen Peroxide Bleaching With and Without Ozone: A Randomized Controlled Trial | Randomized Clinical Trial (RCT) | Evaluation of bleaching sensitivity after bleaching using only hydrogen peroxide 38 (H2O2) or 38% H2O2 and then using ozone | This was a randomized controlled clinical trial involving 80 participants (40 women and 40 men) who were randomly divided into two groups (40 each; 20 women and 20 men). Participants reported tooth sensitivity before and after bleaching using a visual analog scale (VAS) from 0 to 10 | Bleaching sensitivity was reported following both bleaching protocols (p< 0.001). However, participants experienced less bleaching sensitivity when ozone was applied for 60 s after bleaching with 38% H2O2 (p< 0.001). Furthermore, female participants reported greater bleaching sensitivity regardless of the bleaching protocol used (p< 0.05). Bleaching protocols using 38% hydrogen peroxide were associated with less bleaching sensitivity when ozone application was added after bleaching | 20/20 |
9 | Detogni et al. [39] | 2023 | Brazil | Effect of an Experimental Ozone-based Desensitizing Gel on Tooth Sensitivity and In-office Dental Bleaching | Randomized Clinical Trial (RCT) | The evaluation of bleaching effect (BE), tooth sensitivity (TS), and enamel microstructure after in-office tooth bleaching treatment using a desensitizing trial gel containing ozone (O3) | The study included forty third molars, divided into two groups (20 each): one group used an ozone-free desensitizing and bleaching agent (OF-B), while the other group used a 16 ppm ozonized desensitizing agent and bleaching agent (O-B). The study was conducted at the Dental Clinic of the Western State University of Paraná from June 2019 to April 2020 | Tooth sensitivity in the OF-B group was significantly higher than that in the O-B group. However, no significant difference in bleaching effect was observed between the two groups. The experimental gel containing ozone (O3) showed potential as a desensitizing agent for clinical use and effectively reduced tooth sensitivity without affecting the color obtained through tooth bleaching or the enamel microstructure | 17/20 |
10 | Santos et al. [40] | 2024 | Portugal | Antibacterial Effect of Ozone on Cariogenic Bacteria and Its Potential Prejudicial Effect on Dentin Bond Strength—An In Vitro Study | Randomized Clinical Trial (RCT) | The evaluation of the antibacterial effect of ozone on caries-causing bacteria and evaluation of its possible adverse effect on dentin bond strength | This study involved exposing a suspension of four cariogenic bacteria (Streptococcus mutans, Streptococcus sobrinus, Lactobacillus casei, and Actinomyces naeslundii) to ozone gas (40 μg/mL) and ozonized water (60 μg/mL) using ozone medical gene. To assess microtensile bond strength (µTBS), 20 human molars were divided into four groups and prepared with Class I cavities | The use of ozone resulted in a significant reduction in bacterial counts, from 10^6 to 10^1 UFC/mL. However, dentin microtensile bond strength (µTBS) was significantly affected by ozone treatment, with ANOVA results showing a p-value of less than 0.001. While ozone shows promising antibacterial activity against cariogenic bacteria, this study demonstrates its detrimental effect on dentin adhesion. Therefore, caution is advised regarding the use of ozone prior to dental restorative treatments | 18/20 |
11 | Ramirez-Peña et al. [41] | 2022 | Spain | Ozone in patients with periodontitis: a clinical and microbiological study | Randomized Clinical Trial (RCT) | The evaluation of the effectiveness of ozone therapy as a complement to mechanical therapy in patients with generalized periodontitis | A total of 32 patients with generalized periodontitis were enrolled in the study. The study used a split-mouth design, in which each patient's mouth was divided into four quadrants. Clinical variables recorded included gingival index, periodontal clinical attachment loss, Miller mobility index, and clinical improvements assessed by visual analog scale (VAS) | After four weeks of treatment, the ozone-treated quadrants showed a statistically significant reduction in gingival index and improvement in clinical adhesion (p< 0.0001). A significant difference was also observed in the qualitative study of the subgingival flora (p< 0.0001). The overall results of the trial support the conclusion that ozone therapy is effective and well tolerated as an adjunctive treatment in cases of generalized chronic periodontitis | 17/20 |