Efficiency of topical ozone gel as an adjunct to antibiotics and analgesics on sequelae after extraction of impacted mandibular third molar.

Abstract

Introduction: Extraction of the impacted mandibular third molar is a common procedure in dentistry. Many complications may arise after this operation, the most common being pain, trismus, and swelling. Systemic medications have been used in an attempt to manage these problems, but because of their side effects, the need for non-medication treatment arises to treat these complications without side effects, such as cryotherapy, ice packs, low-level laser therapy, and ozone. Ozone is one of the most effective antimicrobials used in the dentistry field, and it also has a positive effect on soft tissue healing, activates cellular metabolism, and can react with blood components; for these reasons ozone is used to manage trismus, swelling, and pain after removal of the mandibular third molar. Aim: The purpose of the study was to assess the effects of topical ozone gel on complications from the extraction of the impacted mandibular third molar.
Materials and Methods: Thirty patients were enrolled in the current study and were randomly divided into two equal groups. Preoperatively clinical examination included measurement of facial swelling measurements and maximum mouth opening. The position and configuration of the impacted lower third molar, the surrounding bone, the mandibular canal, and the neighboring tooth were all assessed using a panoramic X-ray. On days 2 and 7, after surgery, the facial swelling dimensions and maximum mouth opening were again assessed. Statistics were used to analyze results.
Results: Findings indicate statistical significance for pain, but not for swelling or mouth opening.
Conclusions: After lower third molar surgery, topical ozone gel helps reduce postoperative pain.
Keywords: Molar, third; Tooth, impacted; Ozone; Pain; Trismus; Edema.

References

1. Green R, Pynn B, Brauer H. Complications During and After Surgical Removal of Third Molars. Oral Heal Gr. 2013;1:1–11.
2. Deliverska E, Petkova M. Complications After Extraction of Impacted Third Molars - Literature Review. J IMAB. 2016;22(3):1202–11.
3. Lago ML, Dinitz FM, Serna RC, Gude-Sampedro F, Gándara Rey JM, García-García A. Relationships between surgical difficulty and postoperative pain in lower third molar extractions. J Oral Maxillofac Surg. 2007;65:979–983
4. Ra’ed Mohammed Ayoub Al-Delayme, Waleed Kh. Ismael, Mona Abdulhadee Alsafi. Factors associated with facial swelling severity following impacted lower third molar surgery: A prospective study. J Baghdad Coll Dent. 2013;25:122-128
5. Ferrante M, Petrini M, Trentini P, Perfetti G, Spoto G. Effect of low-level laser therapy after extraction of impacted lower third molars. Lasers Med Sci. 2013;28(3):845-9.
6. Thaer Abdul Lateef, Salwan Y. H. Bede, Jamal A. Mohammed. The influence of prophylactic Dexa-methasone on postoperative swelling and trismus following impacted mandibular third molar surgical extraction. J Baghdad Coll Dent. 2010;22:85-90
7. Mocan A, Kisxnisxci R, Uc¸ok C. Stereophoto-grammetric and clinical evaluation of morbidity after removal of lower third molars by two different surgical techniques. J Oral Maxillofac Surg. 1996;54:171–175.
8. van der Westhuijzen AJ, Becker PJ, Morkel J, Roelse JA. A randomized observer blind comparison of bilateral facial ice pack therapy with no ice therapy following third molar surgery. Int J Oral Maxillofac Surg. 2005;34:281–286.
9. Al-Noaman Ahmed Salah. Platelet-rich plasma in oral and dental surgery: A review. Med J Babylon. 2021;8:59-65
10. Ehsan Mansoor Kadhim, Bushra Karem Amin, Bassam Karem Amin. The Antibacterial Effect of Green Tea on Enterococcus faecalis. med j Babylon. 2022;19:676-679
11. Ali S. Abdul-Kareem,Ali H. Al-Hussaini. Effect of platelet rich-fibrin on alveolar osteitis incidence following surgical removal of impacted mandibular third molars: A comparative study. j baghdad coll dent. 2019;34:63-70
12. Gelesko S, Long L, Faulk J, Phillps C, Dicus C, White RP Jr. Cryotherapy and topical minocycline as adjunctive measures to control pain after third molar surgery: an exploratory study. J Oral Maxillofac Surg. 2011;69:324–332.
13. Baysan A, Lynch E. The use of ozone in dentistry and medicine. Prim Dent Care. 2005(2):47-52.
14. Lynch E. Evidence-based caries reversal using ozone. J Esthet Restor Dent. 2008;20(4):218-22.
15. Seidler V, Linetskiy I, Hubálková H, Stanková H, Smucler R, Mazánek J. Ozone and its usage in general medicine and dentistry. A review article. Prague Med Rep. 2008;109(1):5-13.
16. Kazancioglu HO, Kurklu E, Ezirganli S. Effects of ozone therapy on pain, swelling, and trismus following third molar surgery. Int J Oral Maxillofac Surg. 2014;43(5):644-8.
17. Clavo B, Catalá L, Pérez JL, Rodríguez V, Robaina F. Ozone Therapy on Cerebral Blood Flow: A Preliminary Report. Evid Based Complement Alternat Med. 2004;1(3):315-319.
18. Stübinger S, Sader R, Filippi A. The use of ozone in dentistry and maxillofacial surgery: a review. Quintessence Int. 2006;37(5).
19. Bocci V. A. Scientific and medical aspects of ozone therapy. Arch Med Res. 2006;37(4):425–435.
20. Sivalingam VP, Panneerselvam E, Raja KV, Gopi G. Does topical ozone therapy improve patient comfort after surgical removal of impacted mandibular third molar? A randomized controlled trial. J Oral Maxillofac surg. 2017;75(1):51-e1.
21. Bocci V. Ozone as Janus: this controversial gas can be either toxic or medically useful. Mediators inflamm. 2004;13(1):3–11.
22. Lim D, Ngeow WC. A Comparative Study on the Efficacy of Submucosal Injection of Dexame-thasone Versus Methylprednisolone in Reducing Postoperative Sequelae After Third Molar Surgery. J Oral Maxillofac Surg. 2017;75(11):2278–2286.
23. Ajeti NN, Pustina-Krasniqi T, Apostolsk S. The Effect of Gaseous Ozone in Infected Root Canal. Open Access Maced J Med Sci. 2018;6(2):389–396.
24. Walker K, Perkins M, Dray A. Kinins and kinin receptors in the nervous system. Neurochem Int. 1995;26(1):1–26.
25. Domb WC. Ozone therapy in dentistry. A brief review for physicians. Interv neuroradiol. 2014;20(5):632–636.
26. Dray A. Inflammatory mediators of pain. Br J Anaesth. 1995;75(2):125– 131.
27. Bianco E, Maddalone M, Porcaro G, Amosso E, Baldoni M. Treatment of Osteoradionecrosis of the Jaw with Ozone in the Form of Oil-based Gel: 1-year follow-up. J Contemp Dent Prac. 2019;20(2):270–276.
28. Wang J. Neutrophils in tissue injury and repair. Cell tissue res. 2018;371(3):531– 539.
29. Gupta G, Mansi B. Ozone therapy in periodontics. J Med Life. 2012;5:59
30. Huth KC, Jakob FM, Saugel B, Cappello C, Paschos E, Hollweck R, Hickel R, Brand K. Effect of ozone on oral cells compared with established antimicrobials. Eur J Oral Sci. 2006;114(5):435-40. doi: 10.1111/j.1600-0722.2006.00390.x. PMID: 17026511.
31. Patel PV, Gujjari SK. The Morphometrical and Histopathological Changes which were observed after Topical Ozone Therapy on an Exophytic Fibrous Gingival Lesion: A Case Report. J Clin Diagn Res.2013;7:1239.
32. Latt MM, Kiattavorncharoen S, Boon-siriseth K, Pairuchvej V, Wongsirichat. The efficacy of dexamethasone injection on postoperative pain in lower third molar surgery. Jdent anesth pain med. 2016;16:95-102.
33. Raouâa B, Samèh S, Nour B, Abdellatif C, Jamil S. Effects of low-level-laser therapy versus cor-ticotherapy on pain, trismus and edema after surgical removal of third mandibular molars: A comparative study. Family Med Med Sci Res. 2013;2:1-4.
34. ZHANG, W., LI, J., LI, Z.-B. & LI, Z. 2018. Predicting postoperative facial swelling following impacted mandibular third molars extraction by using artificial neural networks evaluation. Sci rep. 2018;8:12281.
35. Ghanem WM, Al-Moudallal Y, Droubi M, Al-Nerabieah Z. Effect of intrasocket application of ozonized olive oil gel on postsurgical pain and soft tissue healing of impacted mandibular third molars surgery: Split-mouth randomized controlled trial. Int J Dent Oral Sci. 2021 Feb 12;8(2):1408-14.
36. A SR, Reddy N, Dinapadu S, Reddy M, Pasari S. Role of ozone therapy in minimal intervention dentistry and endodontics - a review. J Int Oral Health. 2013 Jun;5(3):102-8.
37. Mohammadi Z, Shalavi S, Soltani MK, Asgary S. A review of the properties and applications of ozone in endodontics: an update. Iran Endod J. 2013 Spring;8(2):40-3.
38. Srikanth A, Sathish M, Harsha AV. Application of ozone in the treatment of periodontal disease. J pharm bioallied sci. 2013 Jun;5(Suppl 1):89.
39. Verrazzo G, Coppola L, Luongo C, Sammartino A, Giunta R, Grassia A, Ragone R, Tirelli A. Hyperbaric oxygen, oxygen-ozone therapy, and rheologic parameters of blood in patients with peripheral occlusive arterial disease. Undersea Hyperb Med. 1995;22(1):17-22. PMID: 7742706..
40. Oosting RS, Van Rees-Verhoef M, Verhoef J, Van Golde LM, Van Bree L. Effects of ozone on cellular ATP levels in rat and mouse alveolar macrophages. Toxicology. 1991;70(2):195-202.
41. Bocci V, Luzzi E, Corradeschi F, Silvestri S. Studies on the biological effects of ozone. J Biol Regul Homeost Agents. 1994;8(4):108-12
42. Martínez-Sánchez G, Al-Dalain SM, Menéndez S, Re L, Giuliani A, Candelario-Jalil E, et al. Therapeutic efficacy of ozone in patients with diabetic foot. Eur J Pharmacol. 2005 Oct 31;523(1-3):151-61.
43. Kim K, Brar P, Jakubowski J, Kaltman S, Lopez E. The use of corticosteroids and nonsteroidal anti-inflammatory medication for the management of pain and inflammation after third molar surgery: a review of the literature. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2009;107(5):630-40. doi: 10.1016/j.tripleo.2008.11.005. PMID: 19157919.
44. Azuma K, Mori T, Kawamoto K, Kuroda K, Tsuka T, Imagawa T, Osaki T, Itoh F, Minami S, Okamoto Y. Anti-inflammatory effects of ozonated water in an experimental mouse model. Biomed Rep. 2014;2(5):671-674. doi: 10.3892/br.2014.290. Epub 2014 May 26. PMID: 25054009; PMCID: PMC4106612.
45. da Silva RP, de Almeida VL, de Andrade Vieira W, Rocha FS, Herval ÁM, Nascimento GG, Figueiredo CE, Paranhos LR. Is ozone effective in reducing pain, edema, and trismus after third molar surgery? A systematic review. Research, Society and Develop-ment. 2020 17;9(10):e319108407-.
46. Glória JC, Douglas-de-Oliveira DW, e Silva LD, Falci SG, Dos Santos CR. Influence of ozonized water on pain, oedema, and trismus during impacted third molar surgery: a randomized, triple blind clinical trial. BMC oral health. 2020;20:1-9.
47. Balakrishnan G, Narendar R, Kavin T, Venkataraman S, Gokulanathan S. Incidence of Trismus in Transalveolar Extraction of Lower Third Molar J Pharm Bioallied Sci. 2017;9(1):222–27.
48. Shokry M, Alshaimaa S. Effect of xenograft-ozonated gel mixture on alveolar bone healing following removal of impacted third molar: A randomized controlled clinical trial. Egypt Dent J . 2016;62(4):4749-57.
49. Erdemci F, Gunaydin Y, Sencimen M, Bassorgun I, Ozler M, Oter S, Gulses A, Gunal A, Sezgin S, Bayar GR, Dogan N, Gider IK. Histomorphometric evaluation of the effect of systemic and topical ozone on alveolar bone healing following tooth extraction in rats. Int J Oral Maxillofac Surg. 2014;43(6):777-83. doi: 10.1016/j.ijom.2013.12.007. Epub 2014 Jan 31. PMID: 24491848.
50. Schultze-Mosgau S, Schmelzeisen R, Frölich JC, Schmele H. Use of ibuprofen and methylpred-nisolone for the prevention of pain and swelling after removal of impacted third molars. J oral maxillofac surg. 1995;53(1):2-7.
51. Alkholy SS, Abdallah MA, Abdullah AB. Evaluation of Topical Ozone Gel on Postoperative Sequelae Following Impacted Lower Third Molar Surgery. Al-Azhar Assiut Dent J. 2019;2(2):125-33.
52. Yousef E, Ateia I, Mansour N, Abdelsameaa S. Impact of Ozone gel, PRF & A-PRF on Pain and Trismus during Tissue Healing after Extraction of Mandibular Third Molars. Egypt Dent J. 2021;67(3):2075-89.
53. Bahl D, Samuel S, Charyulu RN, Dole S. Use of topical ozone therapy for wound healing after transalveolar extractions: a miracle alternative therapy. World Journal of Dentistry. 2021;13(1):57-61.
54. Varghese G. Management of impacted third molars. Oral and Maxillofacial Surgery for the Clinician. 2021:299-328.
Published
2023-10-31
How to Cite
ALHELU, Osama A.; MAHDI, Zainab F.; ABDULHAMEED, Balsam Saadi. Efficiency of topical ozone gel as an adjunct to antibiotics and analgesics on sequelae after extraction of impacted mandibular third molar.. Journal of Oral Research, [S.l.], v. 12, n. 1, p. 168-181, oct. 2023. ISSN 0719-2479. Available at: <https://joralres.com/index.php/JOralRes/article/view/joralres.2023.015>. Date accessed: 04 mar. 2024. doi: https://doi.org/10.17126/joralres.2023.015.
Section
Articles