Abstract
Objectives
The aim of this randomized, three-arm parallel, single-blinded clinical trial was to evaluate the clinical and microbiological effectiveness of the ozone application in two-visit indirect pulp therapy.
Materials and methods
One hundred five lower first molar teeth with deep caries lesion were included and randomly assigned three groups to apply the two-visit indirect pulp therapy. Treatment procedure was applied without any disinfectant (control), with 60-s 2% chlorhexidine digluconate (CHX) or 60-s ozone application. In four different stages (after initial excavation, ozone/CHX application before the temporary restoration, 4 months later immediately after removing temporary restoration, and final excavation), dentin humidity, consistency, and color properties were recorded to evaluate the clinical characteristics of the tissue, and standard dentin samples were collected for the microbiological analysis of mutans streptococci, lactobacilli, and the total number of colony-forming units. The data were analyzed by using Mann-Whitney U test for multiple comparisons.
Results
The remaining dentin became harder, drier, and darker after 4 months in all groups. However, CHX and ozone application were statistically better than the control group (p < 0.05). There was a gradual decrease in the total number of microorganisms in all groups. While cavity disinfectant applications were improved the antibacterial efficacy (control, 79.11%; CHX, 98.39%; ozone, 93.33%), CHX application exhibited a greater significant reduction than both groups (p = 0.000).
Conclusion
The two-visit indirect pulp therapy yielded successful results for all study groups. However, CHX would be conveniently preferable due to improving the treatment success.
Clinical relevance
The two-visit indirect pulp therapy applied with cavity disinfectant is a proper alternative treatment procedure in deep carious lesions, instead of conventional technique.
Similar content being viewed by others
References
Bjorndal L, Reit C, Bruun G, Markvart M, Kjaeldgaard M, Nasman P, Thordrup M, Dige I, Nyvad B, Fransson H, Lager A, Ericson D, Petersson K, Olsson J, Santimano EM, Wennstrom A, Winkel P, Gluud C (2010) Treatment of deep caries lesions in adults: randomized clinical trials comparing stepwise vs. direct complete excavation, and direct pulp capping vs. partial pulpotomy. Eur J Oral Sci 118:290–297. https://doi.org/10.1111/j.1600-0722.2010.00731.x
Magnusson BO, Sundell SO (1977) Stepwise excavation of deep carious lesions in primary molars. J Int Assoc Dent Child 8:36–40
Leksell E, Ridell K, Cvek M, Mejare I (1996) Pulp exposure after stepwise versus direct complete excavation of deep carious lesions in young posterior permanent teeth. Endod Dent Traumatol 12:192–196
Orhan AI, Oz FT, Orhan K (2010) Pulp exposure occurrence and outcomes after 1- or 2-visit indirect pulp therapy vs complete caries removal in primary and permanent molars. Pediatr Dent 32:347–355
Falster CA, Araujo FB, Straffon LH, Nor JE (2002) Indirect pulp treatment: in vivo outcomes of an adhesive resin system vs calcium hydroxide for protection of the dentin-pulp complex. Pediatr Dent 24:241–248
Fairbourn DR, Charbeneau GT, Loesche WJ (1980) Effect of improved Dycal and IRM on bacteria in deep carious lesions. J Am Dent Assoc 100:547–552
Leung RL, Loesche WJ, Charbeneau GT (1980) Effect of Dycal on bacteria in deep carious lesions. J Am Dent Assoc 100:193–197
Bjorndal L, Larsen T, Thylstrup A (1997) A clinical and microbiological study of deep carious lesions during stepwise excavation using long treatment intervals. Caries Res 31:411–417
Bjorndal L, Larsen T (2000) Changes in the cultivable flora in deep carious lesions following a stepwise excavation procedure. Caries Res 34:502–508 16631
Maltz M, de Oliveira EF, Fontanella V, Bianchi R (2002) A clinical, microbiologic, and radiographic study of deep caries lesions after incomplete caries removal. Quintessence Int 33:151–159
Pinto AS, de Araujo FB, Franzon R, Figueiredo MC, Henz S, Garcia-Godoy F, Maltz M (2006) Clinical and microbiological effect of calcium hydroxide protection in indirect pulp capping in primary teeth. Am J Dent 19:382–386
Orhan AI, Oz FT, Ozcelik B, Orhan K (2008) A clinical and microbiological comparative study of deep carious lesion treatment in deciduous and young permanent molars. Clin Oral Investig 12:369–378. https://doi.org/10.1007/s00784-008-0208-6
Bjorndal L, Thylstrup A (1998) A practice-based study on stepwise excavation of deep carious lesions in permanent teeth: a 1-year follow-up study. Community Dent Oral Epidemiol 26:122–128
Polydorou O, Halili A, Wittmer A, Pelz K, Hahn P (2012) The antibacterial effect of gas ozone after 2 months of in vitro evaluation. Clin Oral Investig 16:545–550. https://doi.org/10.1007/s00784-011-0524-0
Duque C, Negrini Tde C, Hebling J, Spolidorio DM (2005) Inhibitory activity of glass-ionomer cements on cariogenic bacteria. Oper Dent 30:636–640
Hori R, Kohno S, Hoshino E (1997) Bactericidal eradication from carious lesions of prepared abutments by an antibacterial temporary cement. J Prosthet Dent 77:348–352. https://doi.org/10.1016/S0022-3913(97)70157-4
Kidd EA (1991) Role of chlorhexidine in the management of dental caries. Int Dent J 41:279–286
Azarpazhooh A, Limeback H (2008) The application of ozone in dentistry: a systematic review of literature. J Dent 36:104–116. https://doi.org/10.1016/j.jdent.2007.11.008
Millar BJ, Hodson N (2007) Assessment of the safety of two ozone delivery devices. J Dent 35:195–200. https://doi.org/10.1016/j.jdent.2006.07.010
Celiberti P, Pazera P, Lussi A (2006) The impact of ozone treatment on enamel physical properties. Am J Dent 19:67–72
Nagayoshi M, Kitamura C, Fukuizumi T, Nishihara T, Terashita M (2004) Antimicrobial effect of ozonated water on bacteria invading dentinal tubules. J Endod 30:778–781 00004770-200411000-00007
Kidd EA (2004) How ‘clean’ must a cavity be before restoration? Caries Res 38:305–313. https://doi.org/10.1159/000077770
Bjorndal L, Kidd EA (2005) The treatment of deep dentine caries lesions. Dent Update 32:402–4, 407-10, 413
Schulz KF, Altman DG, Moher D, Group C (2010) CONSORT 2010 statement: updated guidelines for reporting parallel group randomised trials. PLoS Med 7:e1000251. https://doi.org/10.1371/journal.pmed.1000251
Bjorndal L, Demant S, Dabelsteen S (2014) Depth and activity of carious lesions as indicators for the regenerative potential of dental pulp after intervention. J Endod 40:S76–S81. https://doi.org/10.1016/j.joen.2014.01.016
Kidd EA, Joyston-Bechal S, Beighton D (1993) Microbiological validation of assessments of caries activity during cavity preparation. Caries Res 27:402–408
Ricketts DN, Kidd EA, Innes N and Clarkson J (2006) Complete or ultraconservative removal of decayed tissue in unfilled teeth. Cochrane Database Syst Rev:CD003808. https://doi.org/10.1002/14651858
Cohen S, Berman LH, Blanco L, Bakland L, Kim JS (2006) A demographic analysis of vertical root fractures. J Endod 32:1160–1163. https://doi.org/10.1016/j.joen.2006.07.008
Kidd E (2000) The cartwright prize. caries removal and the pulpo-dentinal complex. Dent Update 27:476–482
Tziafas D, Smith AJ, Lesot H (2000) Designing new treatment strategies in vital pulp therapy. J Dent 28:77–92 S0300-5712(99)00047-0
Borges FM, de Melo MA, Lima JP, Zanin IC, Rodrigues LK (2012) Antimicrobial effect of chlorhexidine digluconate in dentin: in vitro and in situ study. J Conserv Dent 15:22–26. https://doi.org/10.4103/0972-0707.92601
Kollmuss M, Kist S, Obermeier K, Pelka AK, Hickel R, Huth KC (2014) Antimicrobial effect of gaseous and aqueous ozone on caries pathogen microorganisms grown in biofilms. Am J Dent 27:134–138
Bocci V (2004) Ozone as Janus: this controversial gas can be either toxic or medically useful. Mediat Inflamm 13:3–11. https://doi.org/10.1080/0962935062000197083
Safwat O, Elkateb M, Dowidar K, El Meligy O (2017) Clinical evaluation of ozone on dentinal lesions in young permanent molars using the stepwise excavation. J Clin Pediatr Dent 41:429–441. https://doi.org/10.17796/1053-4628-41.6.3
Camp JH, Barrett EJ, Pulver F (2002) Pediatric endodontics: endodontic treatment for the primary and young, permanent dentition. In: Cohen S, Burns RC (eds) Book title. Mosby Inc, 8th edn St Louis
Safwat O, Elkateb M, Dowidar K, Salam HA, El Meligy O (2018) Microbiological evaluation of ozone on dentinal lesions in young permanent molars using the stepwise excavation. J Clin Pediatr Dent 42:11–20. https://doi.org/10.17796/1053-4628-42.1.3
Krunic J, Stojanovic N, Dukic L, Roganovic J, Popovic B, Simic I, Stojic D (2018) Clinical antibacterial effectiveness and biocompatibility of gaseous ozone after incomplete caries removal. Clin Oral Investig. https://doi.org/10.1007/s00784-018-2495-x
Kapdan A, Oztas N, Sumer Z (2013) Comparing the antibacterial activity of gaseous ozone and chlorhexidine solution on a tooth cavity model. J Clin Exp Dent 5:e133–e137. https://doi.org/10.4317/jced.51130
Hauser-Gerspach I, Pfaffli-Savtchenko V, Dahnhardt JE, Meyer J, Lussi A (2009) Comparison of the immediate effects of gaseous ozone and chlorhexidine gel on bacteria in cavitated carious lesions in children in vivo. Clin Oral Investig 13:287–291. https://doi.org/10.1007/s00784-008-0234-4
Bocci VA (2006) Scientific and medical aspects of ozone therapy. State of the art. Arch Med Res 37:425–435. https://doi.org/10.1016/j.arcmed.2005.08.006
Polydorou O, Pelz K, Hahn P (2006) Antibacterial effect of an ozone device and its comparison with two dentin-bonding systems. Eur J Oral Sci 114:349–353. https://doi.org/10.1111/j.1600-0722.2006.00363.x
Fagrell TG, Dietz W, Lingstrom P, Steiniger F, Noren JG (2008) Effect of ozone treatment on different cariogenic microorganisms in vitro. Swed Dent J 32:139–147
Baysan A, Beighton D (2007) Assessment of the ozone-mediated killing of bacteria in infected dentine associated with non-cavitated occlusal carious lesions. Caries Res 41:337–341. https://doi.org/10.1159/000104790
Johansson E, Claesson R, van Dijken JW (2009) Antibacterial effect of ozone on cariogenic bacterial species. J Dent 37:449–453. https://doi.org/10.1016/j.jdent.2009.02.004
Ersin NK, Uzel A, Aykut A, Candan U, Eronat C (2006) Inhibition of cultivable bacteria by chlorhexidine treatment of dentin lesions treated with the ART technique. Caries Res 40:172–177. https://doi.org/10.1159/000091120
Huang GT (2008) A paradigm shift in endodontic management of immature teeth: conservation of stem cells for regeneration. J Dent 36:379–386. https://doi.org/10.1016/j.jdent.2008.03.002
Pereira JC, Stanley HR (1981) Pulp capping: influence of the exposure site on pulp healing--histologic and radiographic study in dogs' pulp. J Endod 7:213–223. https://doi.org/10.1016/S0099-2399(81)80178-1
Camp JH (1984) Pulp therapy for primary and young permanent teeth. Dent Clin N Am 28:651–668
Yoshiyama M, Doi J, Nishitani Y, Itota T, Tay FR, Carvalho RM, Pashley DH (2004) Bonding ability of adhesive resins to caries-affected and caries-infected dentin. J Appl Oral Sci 12:171–176
Hayashi M, Fujitani M, Yamaki C, Momoi Y (2011) Ways of enhancing pulp preservation by stepwise excavation-a systematic review. J Dent 39:95–107. https://doi.org/10.1016/j.jdent.2010.10.012
Hevinga MA, Opdam NJ, Frencken JE, Truin GJ, Huysmans MCDNJM (2010) Does incomplete caries removal reduce strength of restored teeth? J Dent Res 89:1270–1275. https://doi.org/10.1177/0022034510377790
Schwendicke F, Meyer-Lueckel H, Dorfer C, Paris S (2013) Failure of incompletely excavated teeth-a systematic review. J Dent 41:569–580. https://doi.org/10.1016/j.jdent.2013.05.004
Gopikrishna V, Pradeep G, Venkateshbabu N (2009) Assessment of pulp vitality: a review. Int J Paediatr Dent 19:3–15. https://doi.org/10.1111/j.1365-263X.2008.00955.x
Hoefler V, Nagaoka H, Miller CS (2016) Long-term survival and vitality outcomes of permanent teeth following deep caries treatment with step-wise and partial-caries-removal: a systematic review. J Dent 54:25–32. https://doi.org/10.1016/j.jdent.2016.09.009
Funding
This project was supported by Turkish Scientific and Technical Research Council (TUBITAK). Project No: 213S004.
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Conflict of interest
The authors declare that they have no conflict of interest.
Ethical approval
All procedures performed in this study involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.
Informed consent
All parents of the participants gave their informed consent prior to their inclusion in the study.
Additional information
Publisher’s note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
Electronic supplementary material
ESM 1
(DOCX 37 kb)
Rights and permissions
About this article
Cite this article
Durmus, N., Tok, Y.T., Kaya, S. et al. Effectiveness of the ozone application in two-visit indirect pulp therapy of permanent molars with deep carious lesion: a randomized clinical trial. Clin Oral Invest 23, 3789–3799 (2019). https://doi.org/10.1007/s00784-019-02808-0
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00784-019-02808-0