Disinfection Effect of Gaseous Ozone on Candida albicans and Enterococcus faecalis: A Randomized Clinical Trial in Infected Primary Molars

Abstract

Objective: The current clinical randomized study’s primary purpose was to investigate the antimicrobial efficiency of gaseous ozone on primary teeth root canals. Methods: The included teeth were randomly divided into three groups, and in each group, the root canal therapies of 12 primary teeth were done. In group 1, 2.5% sodium hypochlorite was applied as an irrigation agent. In group 2, 0.9% sterile saline solution was combined with 80 sec- onds OzonyTronX® application. In group 3, 2.5% sodium hypochlorite was applied as an intracanal medicament in combination with 80 seconds OzonyTronX®. Microbial analyses assessed the colo- nization of Candida albicans and Enterococcus faecalis before and after the procedure. Results: Thirty-six primary molars of 36 completely healthy patients (aged 5-10) were included in the study. The results revealed that the percentage decrease in the number of C. albicans was higher in group 3 (99.3%). This decrease was statistically higher than group 1 (96.1%) and group 2 (94.2%). Group 1 showed better results in eliminating the viable C. albicans versus group 2 (P = .033). The decrease in the number of E. faecalis was higher in group 3 (99.4%) compared to group 1 (99.1%) and group 2 (98.7%) (P = .006). Although the percentage of the unviable microor- ganisms was higher in group 1, there was no statistical difference versus group 2 (P > .05). Conclusion: Using gaseous ozone alone or in combination with sodium hypochlorite may enhance the success of the antimicrobial stage of primary root canal therapies. It could be an alternative to toxic chemical agents such as highly concentrated sodium hypochlorite. Keywords: Dentistry, disinfection agents, ozone, pediatric dentistry, primary teeth, root canal treatment ÖZ Amaç: Bu çalışmada ozon gazının süt dişi kök kanalları üzerindeki antimikrobiyal etkinliğinin ince- lenmesi amaçlanmıştır. Yöntemler: Dahil edilen dişler rastgele three gruba ayrıldı ve her grupta 12 süt dişinin kanal teda- visi yapıldı. Grup 1’de irrigasyon ajanı olarak %2,5 NaOCl uygulandı. Grup 2’de %0,9 steril salin solüsyonu 80 saniye OzonyTronX® uygulaması ile kombine edildi. Grup 3’te %2,5 NaOCl kanal içi ilaç olarak 80 saniye OzonyTronX® ile kombinasyon halinde uygulandı. Mikrobiyal analizler ile işlemden önce ve sonra C. albicans ve E. faecalis’in kolonizasyonu değerlendirdi. Bulgular: Tamamen sağlıklı 36 hastanın (5-10 yaş arası) 36 süt azı dişi çalışmaya dahil edildi. Sonuçlar, Candida albicans sayısındaki azalmanın Grup 3’te (%99,3) daha yüksek olduğunu ortaya koydu. Bu azalma Grup 1 (%96,1) ve Grup 2’ye (%94,2) göre istatistiksel olarak daha yüksekti. Grup 1’in Candida Albicans üzerindeki antimikrobiyal etkisi Grup 2’ye kıyasla daha yüksek bulundu (P = ,033). Enterococcus faecalis sayısındaki azalma Grup 3’te (%99,4) Grup 1 (%99,1) ve Grup 2’ye (%98,7) göre daha fazlaydı (P = ,006). Canlı olmayan mikroorganizmaların yüzdesi Grup 1’de daha yüksek olmasına rağmen, Grup 2’ye göre istatistiksel olarak anlamlı bir fark tespit edilemedi (P > ,05). Sonuç: Ozone gazının yalnız ya da sodyum hipoklorit ile kombine kullanımının süt dişi kanal tedavilerinin antimikrobiyal etkinliğini arttırabileceği ve bu uygulamanın toksik kimyasal kanal içi dezenfektanlara alternatif olabileceği düşünülmektedir. Anahtar Kelimeler: Diş hekimliği, dezenfekte edici ajanlar, ozon, çocuk diş hekimliği, süt dişleri, kök kanal tedavisi

Keywords

• Dentistry
• disinfection agents
• ozone
• pediatric dentistry
• primary teeth

References

1. 1. American Academy of Pediatric Dentistry. Pulp Therapy for Primary and Immature Permanent Teeth. The Reference Manual of Pediatric Dentistry. American Academy of Pediatric Dentistry; 2022:415-423
2. 2. Kapdan A, Kustarci A, Tunç T, Sumer Z, Arslan S. Which is the most effective disinfection method in primary root canals: conventional or newly developed ones? NigerJ Clin Pract. 2015;18(4):538-543. [CrossRef]
3. 3. Agarwal S, Tyagi P, Deshpande A, Yadav S, Jain V, Rana KS. Compari- son of antimicrobial efficacy of aqueous ozone, green tea, and normal saline as irrigants in pulpectomy procedures of primary teeth. J Indian Soc Pedod Prev Dent. 2020;38(2):164-170. [CrossRef]
4. 4. Öter B, Topçuog Lu N, Tank MK, Çehreli SB. Evaluation of antibacterial efficiency of different root canal disinfection techniques in primary teeth. Photomed Laser Surg. 2018;36(4):179-184. [CrossRef]
5. 5. da Silva LA, Nelson-Filho P, Faria G, de Souza-Gugelmin MC, Ito IY. Bacterial profile in primary teeth with necrotic pulp and periapical lesions. Braz Dent J. 2006;17(2):144-148. [CrossRef]
6. 6. Silva EJNL, Prado MC, Soares DN, Hecksher F, Martins JNR, Fidalgo TKS. The effect of ozone therapy in root canal disinfection: a systematic review. Int Endod J. 2020;53(3):317-332. [CrossRef]
7. 7. Gomes BPFA, Herrera DR. Etiologic role of root canal infection in apical periodontitis and its relationship with clinical symptomatol- ogy. Braz Oral Res. 2018;32(suppl 1):e69. [CrossRef]
8. 8. Vasavada K, Kapoor S. Evaluation of ozonized calcium hydroxide as an effective intracanal medicament during root canal procedures: an in vitro observational study. Med Gas Res. 2020;10(3):122-124. [CrossRef]

9. 9. Zan R, Alacam T, Hubbezoglu I, et al. Antibacterial efficacy of super- oxidized water on Enterococcus faecalis biofilms in root canal. Jundishapur J Microbiol. 2016;9(9):e3000 10. Kapdan A, Öztaş N, Sümer Z. Comparing the antibacterial activity of gaseous ozone and chlorhexidine solution on a tooth cavity model.J Clin Exp Dent. 2013;5(3):e133-e137. [CrossRef]
10. 11. Estrela C, Holland R, Estrela CRDA, Alencar AH, Sousa-Neto MD, Pécora JD. Characterization of successful root canal treatment. Braz Dent J. 2014;25(1):3-11. [CrossRef]
11. 12. Trope M, Debelian G. Microbial control: the first stage of root canal treatment. Gen Dent. 2009;57(6):580-588
12. 13. Zehnder M. Root canal irrigants. J Endod. 2006;32(5):389-398. [CrossRef]
13. 14. Fidalgo TKDS, Barcelos R, Portela MB, Soares RM, Gleiser R, Silva- Filho FC. Inhibitory activity of root canal irrigants against Candida albicans, Enterococcus faecalis and Staphylococcus aureus. Braz Oral Res. 2010;24(4):406-412. [CrossRef]
14. 15. Neelakantan P, Herrera DR, Pecorari VGA, Gomes BPFA. Endotoxin levels after chemomechanical preparation of root canal s with sodium hypochlorite or chlorhexidine: a systematic review of clinical trials and meta-analysis. Int Endod J. 2019;52(1):19-27. [CrossRef]
15. 16. Goswami M, Chhabra N, Kumar G, Verma M, Chhabra A. Sodium hypochlorite dental accidents. Paediatr Int Child Health. 2014;34(1):66-69. [CrossRef]
16. 17. Kist S, Kollmuss M, Jung J, Schubert S, Hickel R, Huth KC. Compari- son of ozone gas and sodium hypochlorite/chlorhexidine two-visit disinfection protocols in treating apical periodontitis: a randomized controlled clinical trial. Clin Oral Investig. 2017;21(4):995-1005. [CrossRef]
17. 18. Çolak H, Tokay U, Uzgur R. What role does ozone play in prevent- ing dental caries? An evidence-based review. Ozone Sci Eng. 2015;37(6):563-567. [CrossRef]
18. 19. Azarpazhooh A, Limeback H. The application of ozone in dentistry: a systematic review of literature. J Dent. 2008;36(2):104-116. [CrossRef]
19. 20. Baysan A, Lynch E. The use of ozone in dentistry and medicine. Prim Dent Care. 2005;12(2):47-52. [CrossRef]
20. 21. Çetİnkaya M, Aksoy M, Tulga Öz F. F. Better with ozone, or not? An in-vivo study of ozone therapy as A pre-treatment before fissure seal- ant application. Cumhuriyet Dent J. 2020;23(4):262-272. [CrossRef]
21. 22. Polydorou O, Halili A, Wittmer A, Pelz K, Hahn P. The antibacterial effect of gas ozone after 2 months of in vitro evaluation. Clin Oral Investig. 2012;16(2):545-550. [CrossRef]
22. 23. Srinivasan SR, Amaechi BT. Ozone: A paradigm shift in dental ther- apy. J Glob Oral Health. 2019;2(1):68-77. [CrossRef]
23. 24. Ajeti NN, Pustina-Krasniqi T, Apostolska S. The effect of gaseous ozone in infected root canal. Open Access Maced J Med Sci. 2018;6(2):389-396. [CrossRef]
24. 25. Noites R, Pina-Vaz C, Rocha R, Carvalho MF, Gonçalves A, Pina-Vaz I. Synergistic antimicrobial action of chlorhexidine and ozone in endo- dontic treatment. BioMed Res Int. 2014;2014:592423. [CrossRef]
25. 26. Nagayoshi M, Kitamura C, Fukuizumi T, Nishihara T, Terashita M. Anti- microbial effect of ozonated water on bacteria invading dentinal tubules. J Endod. 2004;30(11):778-781. [CrossRef]
26. 27. Üreyen Kaya B, Kececi AD, Güldaş HE, et al. Efficacy of endodontic applications of ozone and low-temperature atmospheric pressure plasma on root canals infected with Enterococcus faecalis. Lett Appl Microbiol. 2014;58(1):8-15. [CrossRef]
27. 28. Hubbezoglu I, Zan R, Tunc T, Sumer Z. Antibacterial efficacy of aque- ous ozone in root canals infected by Enterococcus faecalis. Jundis- hapur J Microbiol. 2014;7(7):e11411. [CrossRef]
28. 29. Boch T, Tennert C, Vach K, Al-Ahmad A, Hellwig E, Polydorou O. Effect of gaseous Ozone on Enterococcus faecalis biofilm–an in vitro study. Clin Oral Investig. 2016;20(7):1733-1739. [CrossRef]
29. 30. Faul F, Erdfelder E, Lang AG, Buchner AG. G*Power 3: a flexible sta- tistical power analysis program for the social, behavioral, and bio- medical sciences. Behav Res Methods. 2007;39(2):175-191. [CrossRef]
30. 31. Fanning EA. The relationship of dental caries and root resorption of deciduous molars. Arch Oral Biol. 1962;7(5):595-601. [CrossRef]
31. 32. Bezgin T, Oz FT, Ozalp N. Efficacy of Ozone Pretreatment on Fissure Sealant Adaptation and Retention. Ozone Sci Eng. 2022;44(3):317-323. [CrossRef]