Ozone is a triatomic molecule, containing three oxygen atoms. has many different uses in
various fields; one of them is a practice of ozone in medicine (Seidler et al, 2008) as well
as in dentistry field(Azarpazhooh & Limeback 2008). Ozone is unstable gas and release rapidly
a nascent oxygen molecule to form an oxygen gas, due to this property ozone gas used to kill
bacteria, fungi, Inactivate viruses, and control bleeding.(Gupta & Mansi, 2012).
There are three different systems for producing ozone gas: Ultraviolet System: yields low
concentrations of ozone, used in, saunas, esthetics and for air decontamination. Cold Plasma
System: used in water and air decontamination. Corona Discharge System yields a high amount
of ozone. Most commonly used system, corona discharge system easy to manipulate and has a
precise ozone production amount. (Gupta & Mansi, 2012). Ozone has three forms of application
in dentistry ozonated water, ozonated olive oil, ozone gas. Ozonated olive oil and water show
an ideal system to be used due to the ability to trap and discharges oxygen /ozone. (Meena et
al, 2011).
The aims of oxygen/ozone therapy are removal of pathogens, reestablishment of proper oxygen
metabolic rate, stimulation of a pleasant ecologic environment, improve circulation, immune
stimulation, stimulation of an anti-oxidant system.(Gattani & Shewale, 2016).
antimicrobial (antibacterial, antifungal, and antiviral) effect is claimed to be through
damaging to the cytoplasmic membrane, oxidation of intracellular content specific to the
microbial cell, effective in antibiotic resistive strain. Nagayoshi M et al 2004 conducted a
study to evaluate the ability of different concentrations of ozone on survival and
permeability of oral microorganisms. they reported that ozonated water (0.5-4 mg/l) was
greatly effective in killing both gram-positive and gram-negative bacteria. Some strains of
gram-negative bacteria as P. endodontalis and the periodontopathic bacterium P. gingivalis
shows more liability to ozonated water than gram-positive bacteria.(Nagayoshi et al, 2004).
Immunostimulate effect of ozone therapy was reported to be related to its effect on
triggering cellular and humoral immune system, Proliferation of immunocompetent cells,
Synthesis of immunoglobulin's, Enhance phagocytosis activity (V. Bocci, n.d.). Ozone therapy
was found also to have an active role in activation of antioxidants and synthesis of
interleukin, leukotriene, and prostaglandin.( V. Bocci et al, 2009, Gattani & Shewale, 2016)
A systematic review by (V. A. Bocci et al, 2011) was conducted to study the interaction of
ozone therapy and blood. In erythrocytes, it activates phosphofructokinase, thus accelerate
glycolysis and result in increased ATP and 2, 3-diphosphoglycerate. Repeated sessions, allow
lipid oxidation products to reach bone marrow and activate subtle development at
erythropoietin level, this will form new erythrocytes and improved its biochemical
characteristics, a phenomena named "super gifted erythrocytes". This super gifted
erythrocytes was found to have a high content of glucose-6-phosphate dehydrogenase. Ozone
therapy enhanced the phagocytosis effect of neutrophil and trigger cysteine oxidation and
induce the release of cytokines. During the ozone therapy, detection of platelet-derived
growth factor, subunit B, TGF-b1, IL- 8 and epidermal growth factor released in heparinized
plasma(Bocci et al, 2011). A recent randomized controlled trial was conducted to study the
efficiency of ozone therapy in an early healing period of connective tissue gingival graft
placed to cover root surface (Taşdemir et al. 2016)they concluded that, ozone therapy
improved blood profusion during the first week of therapy which could improve wound healing
and decrease post-operative pain.
(Patel et al, 2011) evaluated the therapeutic effects of topical ozonized olive oil on the
healing of post-harvested palatal donor wound sites, with large epithelial and connective
tissue deficiencies that heal by secondary intention. The result revealed that ozonized oil
significantly enhanced re-epithelialization of the palatal donor site wounds.
The main challenge facing periodontal therapy is that of contamination during the early
phases of healing which compromise the initial healing events. In addition, the tissue
response to such inflammatory state that usually associated with marked reduction in anabolic
mediators also compromise periodontal regeneration. Since ozone therapy works on both
bacterial, inflammatory and host anabolic and catabolic mediators, it should be studied
carefully in order to investigate more and augment its role in periodontal therapy.We still
have few investigations with lots of gaps still needs to be investigated. Thus this study
will be performed to approach the effect of ozonized olive oil mixed with the bone substitute
as a biocompatible scaffold and as a possible delivery material in treating Intra-bony
periodontal defects.