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Influence of ozone application in the stepwise excavation of primary molars: a randomized clinical trial

Abstract

Objectives

The aim of this randomized, controlled, three-arm parallel-group, double-blinded clinical trial was to investigate the clinical and microbiological effects of the ozone application in stepwise excavation of primary molars.

Materials and methods

This study was conducted in in vivo conditions with 105 lower primary molars that had deep caries lesions. The teeth were randomly divided into three groups: (I) control group, conventional stepwise excavation with no disinfectants; (II) CHX (positive control) group, 2% chlorhexidine digluconate; and (III) experimental group, ozone application. Dentine samples were collected at 4 different time points (T0, at the first appointment, after partial removal of carious dentin; T1, at the first appointment, after applying disinfection procedure; T2, at the second appointment – at the end of the 4-month period – immediately after the removal of the temporary restoration; T3, at the second appointment, after the final excavation) for the microbiological analysis of mutans streptococci and lactobacilli and the total number of colony-forming units. Clinical changes including dentin color, humidity, and consistency were recorded. Data were analyzed using the Mann-Whitney U test, Friedman test, and chi-squared test (p = 0.05).

Results

The dentin became harder and drier after 4 months in all the groups. There was a gradual reduction in the total number of microorganisms in all the three groups. Bacterial reduction was greater in the CHX group compared to the ozone group (p = 0.002) and was greater in the ozone group compared to the control group (p = 0.015) after 4 months (control, 78%; CHX, 93%; ozone, 82%).

Conclusion

Stepwise excavation of primary teeth provided successful outcomes in all the groups. Moreover, CHX, due to its practicality and cost-effectiveness, can be effectively used with one- or two-step indirect pulp therapies.

Clinical relevance

Usage of cavity disinfectants in the stepwise excavation procedure contributes to the reduction of bacterial population in the cavity, which may allow the avoidance of the second step of the indirect pulp therapy for primary teeth.

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References

  1. 1.

    Thompson V, Craig RG, Curro FA, Green WS, Ship JA (2008) Treatment of deep carious lesions by complete excavation or partial removal: a critical review. J Am Dent Assoc 139:705–712

  2. 2.

    Schwendicke F, Dorfer CE, Paris S (2013) Incomplete caries removal: a systematic review and meta-analysis. J Dent Res 92:306–314. https://doi.org/10.1177/0022034513477425

  3. 3.

    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

  4. 4.

    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

  5. 5.

    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

  6. 6.

    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

  7. 7.

    Bjorndal L (2008) Indirect pulp therapy and stepwise excavation. J Endod 34:S29–S33. https://doi.org/10.1016/j.joen.2008.02.035

  8. 8.

    Bjorndal L, Kidd EA (2005) The treatment of deep dentine caries lesions. Dent Update 32:402–404 407-10, 413

  9. 9.

    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

  10. 10.

    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

  11. 11.

    Wicht MJ, Haak R, Schutt-Gerowitt H, Kneist S, Noack MJ (2004) Suppression of caries-related microorganisms in dentine lesions after short-term chlorhexidine or antibiotic treatment. Caries Res 38:436–441. https://doi.org/10.1159/000079624

  12. 12.

    Meiers JC, Kresin JC (1996) Cavity disinfectants and dentin bonding. Oper Dent 21:153–159

  13. 13.

    Karanika-Kouma A, Dionysopoulos P, Koliniotou-Koubia E, Kolokotronis A (2001) Antibacterial properties of dentin bonding systems, polyacid-modified composite resins and composite resins. J Oral Rehabil 28:157–160

  14. 14.

    Imazato S (2003) Antibacterial properties of resin composites and dentin bonding systems. Dent Mater 19:449–457

  15. 15.

    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

  16. 16.

    Celiberti P, Pazera P, Lussi A (2006) The impact of ozone treatment on enamel physical properties. Am J Dent 19:67–72

  17. 17.

    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

  18. 18.

    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

  19. 19.

    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

  20. 20.

    Kidd EA, Joyston-Bechal S, Beighton D (1993) Microbiological validation of assessments of caries activity during cavity preparation. Caries Res 27:402–408. https://doi.org/10.1159/000261571

  21. 21.

    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

  22. 22.

    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

  23. 23.

    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. doi: https://doi.org/10.1002/14651858.CD003808.pub2

  24. 24.

    Kidd E (2000) The Cartwright Prize. Caries removal and the pulpo-dentinal complex. Dent Update 27:476–482

  25. 25.

    Kidd EA (2004) How ‘clean’ must a cavity be before restoration? Caries Res 38:305–313. https://doi.org/10.1159/000077770

  26. 26.

    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

  27. 27.

    Ersin NK, Candan U, Aykut A, Eronat C, Belli S (2009) No adverse effect to bonding following caries disinfection with chlorhexidine. J Dent Child (Chic) 76:20–27

  28. 28.

    Wadenya R, Menon S, Mante F (2011) Effect of chlorhexidine disinfectant on bond strength of glass ionomer cement to dentin using atraumatic restorative treatment. N Y State Dent J 77:23–26

  29. 29.

    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 23:785–792. https://doi.org/10.1007/s00784-018-2495-x

  30. 30.

    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

  31. 31.

    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

  32. 32.

    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

  33. 33.

    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

  34. 34.

    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

  35. 35.

    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

  36. 36.

    Camp JH, Barrett EJ and Pulver F (2002) Pediatric endodontics: endodontic treatment for the primary and young, permanent dentition. In: Cohen S and Burns RC (eds) Book title. Mosby Inc, 8th Ed. St Louis

  37. 37.

    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

  38. 38.

    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

  39. 39.

    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

  40. 40.

    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

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Funding

This project was supported by Turkish Scientific and Technical Research Council (TUBITAK). Project No: 213S004.

Author information

Correspondence to Merve Akcay.

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.

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The protocols of this study were approved by The Ethical Committee in Human Research of Faculty of Dentistry, Izmir Katip Celebi University (29.08.2013; no.119).

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Cite this article

Mese, M., Tok, Y.T., Kaya, S. et al. Influence of ozone application in the stepwise excavation of primary molars: a randomized clinical trial. Clin Oral Invest (2020). https://doi.org/10.1007/s00784-020-03223-6

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Keywords

  • Chlorhexidine gluconate
  • Dental caries
  • Ozone
  • Stepwise excavation