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Comparison of ozone gas and sodium hypochlorite/chlorhexidine two-visit disinfection protocols in treating apical periodontitis: a randomized controlled clinical trial

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Abstract

Objectives

In this single-blinded, prospective, randomized, controlled clinical trial, the effectiveness of an ozone gas or NaOCl/CHX disinfection protocol was compared within the root canal treatment of apical periodontitis.

Materials and methods

Sixty permanent teeth were randomly allocated to one technique. The clinical/radiographic assessment criteria included clinical symptoms, periapical index (PAI), and size of the apical lesion. In both groups, the root canal was mechanically cleaned and irrigated with NaCl and EDTA. Ozone gas (32 g m−3) or NaOCl (3 %) was applied followed by a 1-week inter-appointment dressing (Ca(OH)2). As final disinfection, ozone gas (ozone group) or CHX 2 % (NaOCl group) was applied. Microbial samples were taken after preparing the access cavity, after chemo-mechanical treatment and after inter-appointment dressing by sterile paper points. Microbial identification was performed by mass spectroscopy (MALDI-TOF-MS) and 16S-rRNA gene sequencing. The treated teeth were blindly re-evaluated after 6/12 months. Success rates, the decrease in PAI, the size of apical lesions and bacterial reduction were compared between groups (Fischer’s exact test, Mann-Whitney U test).

Results

There were no significant differences between the success rates (ozone group: 96.2/95.5 % after 6/12 months; NaOCl group: 95.5/95.2 % after 6/12 months). The differences in the decreases in PAI values and apical lesion sizes were also insignificant after 6 and 12 months. The bacterial reduction showed no significant differences between groups after chemo-mechanical treatment and after inter-appointment dressing. The most commonly found bacterial genera were Streptococcus spp., Parvimonas spp. and Prevotella spp.

Conclusions

The here used ozone gas and NaOCl/CHX protocols showed no difference in bacterial reduction in the sampled areas of the root canals.

Clinical relevance

Within the limitations of the study, ozone gas seems to be a possible alternative disinfection agent within the root canal treatment of apical periodontitis.

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Acknowledgments

We want to thank the medical technician, Ms. C. Wagner, for her kind help in the operation of the MALDI/TOF MS and our colleagues, Dr. L. M. Schlecht, Dr. Y. Malyk and Dr. C. Fotiadou, for patient acquisition. Further, we would like to thank the European Society of Endodontology (ESE) for funding the study by the Annual Research Grant 2013.

Author information

Authors and Affiliations

  1. Department of Restorative Dentistry, Periodontology & Paedodontics, Ludwig Maximilians University, Goethestrasse 70, 80336, Munich, Germany

    Stefan Kist, Maximilian Kollmuss, Reinhard Hickel & Karin Christine Huth

  2. Max-von-Pettenkofer Institute for Hygiene and Clinical Microbiology, Ludwig Maximilians University, Munich, Germany

    Jette Jung & Sören Schubert

Authors
  1. Stefan Kist
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  2. Maximilian Kollmuss
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Corresponding author

Correspondence to Karin Christine Huth.

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Funding

This study was funded by the Annual Research Grant 2013 of the European Society of Endodontology (ESE).

Conflict of interest

The authors declare that they have no competing interests.

Ethical approval

This article does not contain any studies with animals performed by any of the authors. All procedures performed in studies 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

Informed consent was obtained from all individual participants included in the study.

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Kist, S., Kollmuss, M., Jung, J. et al. Comparison of ozone gas and sodium hypochlorite/chlorhexidine two-visit disinfection protocols in treating apical periodontitis: a randomized controlled clinical trial. Clin Oral Invest 21, 995–1005 (2017). https://doi.org/10.1007/s00784-016-1849-5

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  • DOI: https://doi.org/10.1007/s00784-016-1849-5

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