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The effects of ozone therapy on wound healing after gingivectomy operations: a controlled clinical study

Authors:
Ozon tedavisinin gingivektomi operasyonları sonrası yara
iyileşmesi üzerine etkileri: kontrollü klinik çalışma
The eects of ozone therapy on wound healing after gingivectomy
operations: a controlled clinical study
Zekeriya Taşdemir1*, Özge Köy1, Merve Nur Oskaybaş1, Damla Soydan2
1Erciyes Üniversitesi Diş Hekimliği Fakültesi , Periodontoloji AD, Kayseri
2 Erciyes Üniversitesi Diş Hekimliği Fakültesi , Oral Radyoloji AD, Kayseri
Atıf/Citation: Taşdemir, Z., Köy, Ö., Oskaybaş, M.N. & Soydan, D. (2019). Ozon tedavisinin gingivektomi operasyonları sonrası
yara iyileşmesi üzerine etkileri: kontrollü klinik çalışma. Ege Üniversitesi Diş Hekimliği Fakültesi Dergisi, 40(2), 133-140.
Sorumlu yazar/Corresponding author*: Zekeriyatasdemir@hotmail.com
Başvuru Tarihi/Received Date: 04.07.2019
Kabul Tarihi/Accepted Date: 16.07.2019
ÖZ
Amaç: Bu çalışmanın amacı, ozon tedavisinin, gingivektomi ve gingivoplasti ameliyatları sonrası yara
iyileşmesi üzerindeki etkilerini ikincil yara iyileşmesi modelinde değerlendirmektir.
Metod: Çalışmaya sistemik olarak sağlıklı 23 kişi (12 kadın, 11 erkek) katılmıştır. Gingivektomi ve
gingivoplasti işlemleri yapıldı. Bir kadranda ozon tedavisi yapıldı ve kontralateral taraf tüm hastalarda
kontrol tarafı olarak kabul edildi. Postoperatif 3 gün sonra, bir plak boyama ajanı uygulandı ve standart
fotoğraar çekildi. Fotoğraar dijital bir görüntü programında değerlendirildi ve yara alanları milimetre kare
olarak ölçüldü. Ameliyat sonrası ağrı, görsel analog skala ile değerlendirildi. Hastalar ameliyat sonrası 3.,
7. ve 14. günlerde çağrıldı.
Bulgular: Test taraarı postoperatif 3., 7. ve 14. günlerde kontrol taraarına göre daha düşük boyalı yüzey
alanlar gösterdi. VAS ölçeği sonuçları gruplar arasında ağrı ve rahatsızlık açısından anlamlı farklılıklar
göstermiştir. Hastalar postoperatif 3. günde anlamlı olarak daha az ağrı bildirdi, ancak postoperatif 7. ve
14. günlerde anlamlı bir fark yoktu.
Sonuçlar: Bu çalışmanın sınırlılığı dahilinde ozon tedavisi, gingivektomi ve gingivoplasti ameliyatları sonrası
yara iyileşme sürecini geliştirmiş ve postoperatif dönemdeki ağrıdaki azalmasını sağlamıştır.
Anahtar kelimeler: Ozon; yara; gingivektomi
ABSTRACT
Objectives: Aim of the present study was to evaluate the eects of ozone therapy on wound healing after
gingivectomy and gingivoplasty operations as a model of secondary intention wound healing.
Methods: 23 systemically healthy individuals (12 female and 11 male) participated in this study. Gingivectomy
and gingivoplasty procedures were performed. One quadrant received ozone treatment and the contralateral
side was considered as control side in all patients. After postoperative 3 days, a plaque disclosing agent
was applied and standardized photographs were taken. Photographs were evaluated in a digital image
program and wound areas were measured as millimeter squares. Postoperative pain was evaluated via a
visual analog scale. Patients were called at 3rd, 7th and 14th days after surgery.
Results: Test sides showed signicantly lower stained surface areas compared to the control sides on the
postoperative 3rd, 7th and 14th days. VAS scale results showed signicant dierences between groups
in terms of pain and discomfort. Patients reported signicantly lower pain on the postoperative 3rd day,
however, there were no signicant dierences in postoperative 7th and 14th days.
Conclusions: Within the limitation of the present study, ozone treatment improved the wound healing
process after gingivectomy and gingivoplasty surgeries along with the decrease in postoperative pain.
Keywords: Ozone; wound; gingivectomy
Araştırma EÜ Dişhek Fak Derg 2019; 40_2: 133-140
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GİRİŞ
  
1
     
      
        
2
 
      
     
      
    

      
       
      
        
  
    2   
     
      


. Yara
   
     
.
     
    
 
 
      

      
       

     
89
    
       
     

       
     
    
.


    

     
     





    
     
    


    
     

GEREÇ VE YÖNTEMLER

    


    
     


 
 
 
 
 
 
      
    

    
     






      
       
Taşdemir ve ark. 2019
135
EÜ Dişhek Fak Derg 2019; 40_2: 133-140
       
     
    
       
     

 




    
       


      

     

       

     
      
     



      
   
 
  
     
      
    



     
     






        

Graphic 1. Görsel analog skala bulguları
0
2
4
6
8
10
day 3
day 7
day 14
test group
control group
*
Graphic 1.
136

       
      
       
     
     
     



    

        
     
      
 
 
      
     
  
     
  
       
      


      


     
     
      


BULGULAR
       
     

    
     
      
     
     

     
    

       
      

Table 1 
Yaş
Ort.
Min-Max
22.4
18-27
Cinsiyet
Kadın %
Erkek %
12(52.2)
11(47.8)
Table 2

22 
Başlangıç





 
3.gün




1.89
 
7.gün





 
14.gün





 
 <0.005 <0.005
Taşdemir ve ark. 2019
137
Randomizasyon
Kontrol grubu
Test grubu


        
  

TARTIŞMA



      
      


       
     
      
     
     
    
     
  
.
   
     
   

    
      
     
  


    
   
     

     
     
     
28      
    
   
      
     22.


     
 
      
9
        

      
      
EÜ Dişhek Fak Derg 2019; 40_2: 133-140
138
     

     .
      
      

     
 
     
 
       
    
 
 
     
    
     
   
     
  
 

     
    
     

     
.
      
        
  
    
      
    
    
     

     

      
 
     
       
      .



22.
     
     
      
     
     
     
     
     
    
    

REFERANSLAR
       
    


         

       

 
       

      

      

       
      
       

  


       
       

 
       



Taşdemir ve ark. 2019
139
     
  
    


 



        
     

 


 
       
     

       
        
     


      


  
       
    


        

    
    

      
  




        
       
     

   
    
     
     


  
      
      

       
       


       
       
      

       
       
      

        
       
    
    

 
      


          
  

         
      

   
        
     

 

 

EÜ Dişhek Fak Derg 2019; 40_2: 133-140
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 

   

        
       
     
    

 
     

        
     
    
      

 
       

       
     
    
    
     

  
     
     
      
      

 


     
      
     


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Taşdemir ve ark. 2019
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Background The platelet concentrate is a windfall in the field of regenerative therapy in periodontology. It accelerates wound healing by excellent neovascularization and promoting fast cicatricle tissue remodeling. Aim This study aims to evaluate clinically and histologically accelerated effect of platelet-rich fibrin (PRF) membrane and PRF matrix (PRFM) following depigmentation procedure. Materials and Methods Eleven individuals were divided into three groups after depigmentation procedure. PRF membrane and PRFM gel were prepared as per standard protocol. Group A and B received PRF membrane and PRFM gel followed by periodontal dressing, respectively, and the only periodontal dressing was placed in Group C. The individuals were evaluated for visual analog scale (VAS) and healing index (HI) on 3rd and 5th day. Epithelization test and histologic analysis from punch biopsy were done on the 5th day. At 3rd month, reevaluation was performed. Results The intergroup statistical analysis in respect to VAS, HI, epithelization test, and histologic analysis showed a statistically significant results with P < 0.001 in Groups A and B compared to Group C. Clinical evaluation of epithelization test and histologic analysis revealed better-wound healing and moderate to no inflammatory cell infiltrate in Groups A and B, respectively, as compared to Group C, which appeared more erythematous with dense inflammatory cells. Conclusion Thus, the application of PRF membrane and PRFM gel has shown a successful approach to protect the raw wound area of depigmented sites with better patient comfort and faster healing.
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Background Laser phototherapy (LPT) has been suggested as a new therapeutic tool to improve the repair of replanted teeth. However, its effects and mechanism of action are not yet completely understood. Objectives This study evaluated histologically the effect of laser phototherapy (LPT) λ808 and λ660 nm on angiogenesis in the periodontal tissue of replanted teeth in rats. Material and Methods Twenty maxillary right incisors were extracted from twenty Wistar rats and randomly assigned to four groups (n = 5): PN – teeth were stored in paper napkin for 45 min; WM – teeth were immersed in 20 ml of UHT whole cow milk for 45 min; PNL and WML – teeth received the same treatment described for PN and WM, respectively, plus LPT at λ808 and λ660 nm. All root canals were prepared and filled with calcium hydroxide paste. The animals were euthanized 15 days after tooth replantation and angiogenesis was scored by blood vessel counting in the area of periodontal ligament and alveolar bone, using the ImageJ software. Data were analyzed statistically by ANOVA and Tukey’s test (α = 5%). Results LPT at λ808 and λ660 nm caused significant increased angiogenesis on irradiated groups (PNL and WML) when compared to the non-irradiated groups (PN and WM) (p<0.05). There was no statistically significant difference between PN and WM as well as between PNL and WML (p>0.05). Conclusions LPT is capable of stimulating angiogenesis in vivo in the periodontal tissue of replanted teeth. Key words:Angiogenesis, lasers, tooth avulsion, tooth replantation, wound healing.
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Chronic wounds present a significant burden to the health care system and the patient. Ozone therapy has been proposed as a treatment for chronic wounds, potentially acting by eliciting mild oxidative stress or disinfection. The purpose of this systematic review is to evaluate the potential benefits and harms of ozone therapy as an advanced care intervention for chronic wounds. Studies were extracted from Google Scholar, PubMed, the Cochrane Library, and reference lists. General inclusion criteria included English-language randomised human trials reporting the use of ozone therapy in the topical treatment of chronic wounds. Primary outcome data included the extent of chronic wound healing, and secondary outcomes included adverse effects. Studies were assessed for level of bias and data quality. Nine studies (n = 453 patients) matched the inclusion criteria and underwent meta-analysis. Overall, there was a significant improvement in wound closure with ozone therapy. Results consistently favour the application of ozone as a treatment for chronic wounds; however, there is no conclusive evidence of ozone therapy as superior compared with standard treatments. Compared with standard care, ozone therapy as an advanced wound care treatment may improve the proportion of chronic wounds healed in a shorter amount of time, but further research is required.
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Abstract: Platelet-rich plasma (PRP) has been proposed for different applications in the medical field and in maxillofacial surgery thanks to its many growth factors, such as epidermal growth factor (EGF), fibroblast growth factor (FGF), and keratinocyte growth factor (KGF). Oral lichen planus (OLP) is a disease that affects the oral mucosa in a chronic way. This disease frequently worsens the quality of life of patients, particularly when clinical manifestations are of the erythematous or erosive/ulcerative type. The properties of PRP that are supported by scientific literature in both oral medicine and other medical fields have suggested the introduction of PRP in clinical practice for the medical treatment of different soft tissues diseases, such as when OLP patients do not respond to conventional therapies, or when conventional treatments have some contraindications or side effects. The aim of this work is to describe the use of PRP used as an oral rinse for the treatment of a patient diagnosed as affected by OLP at the Dentistry, Special Needs and Maxillo-Facial Surgery Unit of the Hospital of Piacenza. PRP protocol was started after the failure of conventional therapies based on the use of topical and systemic corticosteroids, hydroxychloroquine, and low-level laser therapy applications.
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Skin can be infected by many types of microorganisms, most commonly by gram‑positive strains of Staphylococcus and Streptococcus spp. Treatment of Staphylococcus aureus (S. aureus) infections, particularly that of methicillin resistant Staphylococcus aureus (MRSA), is a challenge in clinical practice. Ozone therapy has proven to be one of the strongest antiseptics against the majority of microorganisms involved in skin infections. The purpose of the present study was to evaluate the microbicidal effects of topical ozone therapy on S. aureus and MRSA, and determine the clinical efficacy of ozone therapy on patients with MRSA skin infection. Microbicidal effects of ozonated oil and ozonated water were determined by plating and Kirby Bauer methods. Clinical efficacy and safety of topical ozone were evaluated in two cases with skin MRSA infection. The killing rates of ozonated oil for S. aureus and MRSA were greater when compared with the control oil group. Almost 100% of S. aureus were eliminated by ozonated oil following 5 min. Almost 100% MRSA were eliminated by ozonated oil following 15 min. In addition, 100% S. aureus and 100% MRSA were eliminated by ozonated water in 1 min. The inhibition zone diameters of ozonated oil for S. aureus and MRSA were 17 and 13 mm, respectively, which were significantly larger than the control group. Both cases of skin MRSA infection were completely healed with ozone therapy. In conclusion, ozone therapy is a potential treatment for S. aureus and MRSA skin infection as it has great efficacy, few side effects and low‑costs.
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Background: Skin injury affects millions of people via the uncontrolled inflammation and infection. Many cellular components including fibroblasts and signaling pathways such as TGF-β were activated to facilitate the wound healing to repair injured tissues. Methods and Results: C57BL/6 female mice were divided into control and ozone oil treated groups. Excisional wounds were created on the dorsal skin and the fibroblasts were isolated from granulation tissues. The skin injured mouse model revealed that ozone oil could significantly decrease the wound area and accelerate wound healing compared with control group. QPCR and western blotting assays showed that ozone oil upregulated collagen I, α-SMA and TGF-β1 mRNA and protein levels in fibroblasts. Wound healing assay demonstrated that ozone oil could increase the migration of fibroblasts. Western blotting assay demonstrated that ozone oil increased the EMT process of fibroblasts via upregulating fibronectin, vimentin, N-cadherin, MMP-2, MMP-9, IGFBP-3, IGFBP5 and IGFBP6 and decreasing epithelial protein E-cadherin and cellular senescence marker p16 expression. Mechanistically, western blotting assay revealed that ozone oil increased the phosphorylation of PI3K, Akt and mTOR to regulate the EMT process, while inhibition of PI3K reversed this effect of ozone oil. At last, the results from Cytometric Bead Array demonstrated ozone oil significantly decreased the inflammation in fibroblasts. Conclusion: Our results demonstrated ozone oil facilitated the wound healing via increasing fibroblast migration and EMT process via PI3K/Akt/mTOR signaling pathway in vivo and vitro. The cellular and molecular mechanisms we found here may provide new therapeutic targets for the treatment of skin injury.
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Oral mucositis (OM) induces severe pain and limits fundamental life behaviors such as eating, drinking, and talking for patients receiving chemotherapy or radiotherapy. In addition, through opportunistic microorganisms, OM frequently leads to systemic infection which then leads to prolonged hospitalization. Severe lesions often adversely affect curative effects in cancer cases. Therefore, the control of OM is important for oral health quality of life and prognosis. Low-level laser therapy (LLLT) and ozone may be useful to accelerate wound healing. In this study, 24 Sprague-Dawley rats were divided into three groups as control, ozone, and laser groups. All groups received 5-fluorouracil intraperitoneally and trauma to the mouth pouch with a needle. After the formation of OM in the mouth, the control group had no treatment; the ozone group was administered ozone, and the laser group, LLLT. Then, all groups were sacrificed and basic fibroblast growth factor (bFGF), transforming growth factor (TGF-β), and platelet-derived growth factor (PDGF) were evaluated in all groups. LLLT was determined to be statistically significantly more effective than ozone on FGF and PDGF. However, in respect of TGF-β, no statistically significant difference was observed between the groups. In conclusion, within the limitations of this study, LLLT is more effective than ozone. However, further studies on this subject are required.
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Ozone-therapy initially applied in medicine by an empirical approach, has now reached a new stage where most of the biological mechanisms of ozone action have been clarified, that refers to antimicrobial effects, immunoregulation, antioxidant defenses and epigenetic modification. Current ozone medical preparation in dermatology mainly classified as ozone hydrotherapy, ozonated oil externally used and ozone autohemotherapy (OAHT). Admittedly, ozone is widely used in various fields against gram-negative and gram-positive bacteria, viruses, and fungi. More recently, great progress has been obtained in wound healing which is a multiphase process that consists of three overlapping but distinct stages: inflammation, tissue proliferation and remodeling. While the exact mechanisms of ozone-therapy still remain unclear. Therefore, more evidence is required before ozone can be presented as a promising method for the management and prevention of various skin diseases. In this review, we review the application status of ozone in dermatology and summarize possible mechanisms of ozone-therapy on skin diseases, aims to shed a light on providing a series of theoretical basis for its applications.
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Purpose: To assess the influence of topical ozone administration on patient comfort after third molar surgery. Materials and methods: A single-blinded randomized controlled clinical trial was designed involving patients who required removal of bilateral impacted mandibular third molars. The predictor variable was the postoperative medication used after third molar surgery. Using the split-mouth design, the study group received topical ozone without postoperative systemic antibiotics, whereas the control group did not receive ozone but only systemic antibiotics. The 2 groups were prescribed analgesics for 2 days. The assessing surgeon was blinded to treatment assignment. The primary outcome variables were postoperative mouth opening, pain, and swelling. The secondary outcome variable was the number of analgesic doses required by each group on postoperative days 3 to 5. Data analysis involved descriptive statistics, paired t tests, and 2-way analysis of variance with repeated measures (P < .05). SPSS 20.0 was used for data analysis. Results: The study sample included 33 patients (n = 33 in each group). The study group showed statistically relevant decreases in postoperative pain, swelling, and trismus. Further, the number of analgesics required was smaller than in the control group. No adverse effects of ozone gel were observed in any patient. Conclusion: Ozone gel was found to be an effective topical agent that considerably improves patient comfort postoperatively and can be considered a substitute of postoperative systemic antibiotics.