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Published in: BMC Oral Health 1/2020

01-12-2020 | Research article

Influence of ozonized water on pain, oedema, and trismus during impacted third molar surgery: a randomized, triple blind clinical trial

Authors: José Cristiano Ramos Glória, Dhelfeson Willya Douglas-de-Oliveira, Larissa Doalla Almeida e Silva, Saulo Gabriel Moreira Falci, Cássio Roberto Rocha dos Santos

Published in: BMC Oral Health | Issue 1/2020

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Abstract

Background

This study aimed to evaluate the efficacy of ozonized water on pain, oedema and trismus after impacted third molar mandibular surgeries when compared to double distilled water. A randomized triple blind trial was conducted.

Methods

Patients with third molars class II-B of Pell-Gregory were included, and surgical extraction was performed. Irrigation was done with ozonized (group 1) or double distilled water (group 2). The type of irrigation and the side to be operated were randomized. Neither the patients nor the operator or evaluator were aware of the irrigation solution. Pain, oedema and trismus were evaluated at baseline, 24-h, 48-h, 72-h and 7-days after treatment. The data were evaluated by Friedman, Wilcoxon, Mann-Whitney tests, and size effect.

Results

It was included 8 men and 12 women, with a mean age of 20.9y.o. The initial pain mean was 7.94 (±12.81) (group 1) and 5.50 (±9.12) (group 2) (p > 0,05). There was a statistically significant reduction of pain, oedema and trismus in intragroup analysis (p < 0.05). There was no statistically significant difference (p > 0.05) when comparing the oedema and trismus between groups. The size effect ranged from small (0.23) to large (1.29).

Conclusions

It was concluded that ozonized water was compatible as irrigation method, not inferior to double distilled water, and had satisfactory effects on management of pain, oedema and trismus after surgical removal of the third molar.

Trial registration

This clinical trial was registered in ClinicalTrials.gov NCT03501225 on April 18, 2018.
Literature
1.
go back to reference Bocci V. Biological and clinical effects of ozone Has ozone therapy a future in medicine? Br J Biomed Sci. 1999;56:270–9.PubMed Bocci V. Biological and clinical effects of ozone Has ozone therapy a future in medicine? Br J Biomed Sci. 1999;56:270–9.PubMed
2.
go back to reference Elvis AM, Ekta JS. Ozone therapy: a clinical review. J Nat Sci Biol Med. 2011;2:66–70.CrossRef Elvis AM, Ekta JS. Ozone therapy: a clinical review. J Nat Sci Biol Med. 2011;2:66–70.CrossRef
3.
go back to reference Seidler V, Linetskiy I, Hubálková H, Staňková H, Šmucler R, Mazánek J. Ozone and its usage in general medicine and dentistry. A review article. Prague Med Rep. 2008;109:5–13.PubMed Seidler V, Linetskiy I, Hubálková H, Staňková H, Šmucler R, Mazánek J. Ozone and its usage in general medicine and dentistry. A review article. Prague Med Rep. 2008;109:5–13.PubMed
4.
go back to reference 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;114:435–40.CrossRef 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;114:435–40.CrossRef
5.
go back to reference 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;43:644–8.CrossRef 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;43:644–8.CrossRef
6.
go back to reference Nagayoshi M, Fukuizumi T, Kitamura C, Yano J, Terashita M, Nishihara T. Efficacy of ozone on survival and permeability of oral micro-organisms. Oral Microbiol Immunol. 2004;19:240–6.CrossRef Nagayoshi M, Fukuizumi T, Kitamura C, Yano J, Terashita M, Nishihara T. Efficacy of ozone on survival and permeability of oral micro-organisms. Oral Microbiol Immunol. 2004;19:240–6.CrossRef
7.
go back to reference Falci SG, Santos RC, de Souza Lima LD, Ramos-Jorge ML, Botelho AM, Dos Santos CRR. Association between the presence of a partially erupted mandibular third molar and the existence of caries in the distal of the second molars. Int J Oral Maxillofac Surg. 2012;41:1270–4.CrossRef Falci SG, Santos RC, de Souza Lima LD, Ramos-Jorge ML, Botelho AM, Dos Santos CRR. Association between the presence of a partially erupted mandibular third molar and the existence of caries in the distal of the second molars. Int J Oral Maxillofac Surg. 2012;41:1270–4.CrossRef
8.
go back to reference Irja V. Impacted third molars increase the risk for caries and periodontal pathology in neighboring second molars. J Evid Based Dent Pract. 2014;14:89–90.CrossRef Irja V. Impacted third molars increase the risk for caries and periodontal pathology in neighboring second molars. J Evid Based Dent Pract. 2014;14:89–90.CrossRef
9.
go back to reference Vigneswaran AT, Shilpa S. The incidence of cysts and tumors associated with impacted third molars. Int J Oral Maxillofac Surg. 2015;7:S251–4. Vigneswaran AT, Shilpa S. The incidence of cysts and tumors associated with impacted third molars. Int J Oral Maxillofac Surg. 2015;7:S251–4.
10.
go back to reference de Santana-Santos T, de Souza-Santos a A, Martins-Filho PR, da Silva LC, de Oliveira E Silva ED, Gomes AC. Prediction of postoperative facial swelling, pain and trismus following third molar surgery based on preoperative variables. Med Oral Patol Oral Cir Bucal. 2013;18:e65–70.CrossRef de Santana-Santos T, de Souza-Santos a A, Martins-Filho PR, da Silva LC, de Oliveira E Silva ED, Gomes AC. Prediction of postoperative facial swelling, pain and trismus following third molar surgery based on preoperative variables. Med Oral Patol Oral Cir Bucal. 2013;18:e65–70.CrossRef
11.
go back to reference Kazancioglu HO, Ezirganli S, Demirtas N. Comparison of the influence of ozone and laser therapies on pain, swelling, and trismus following impacted third-molar surgery. Lasers Med Sci. 2014;29:1313–9.CrossRef Kazancioglu HO, Ezirganli S, Demirtas N. Comparison of the influence of ozone and laser therapies on pain, swelling, and trismus following impacted third-molar surgery. Lasers Med Sci. 2014;29:1313–9.CrossRef
12.
go back to reference Apers S, Luyckx K, Moons P. Is quality of life the ultimate outcome parameter? Eur J Cardiovasc Nurs. 2013;12:502–4.CrossRef Apers S, Luyckx K, Moons P. Is quality of life the ultimate outcome parameter? Eur J Cardiovasc Nurs. 2013;12:502–4.CrossRef
13.
go back to reference Forouzanfar T, Sabelis A, Ausems S, Baart JA, van der Waal I. Effect of ice compression on pain after mandibular third molar surgery: a single-blind, randomized controlled trial. Int J Oral Maxillofac Surg. 2008;37:824–30.CrossRef Forouzanfar T, Sabelis A, Ausems S, Baart JA, van der Waal I. Effect of ice compression on pain after mandibular third molar surgery: a single-blind, randomized controlled trial. Int J Oral Maxillofac Surg. 2008;37:824–30.CrossRef
14.
go back to reference Nogales CG, Ferrari PA, Kantorovich EO, Lage-Marques JL. Ozone therapy in medicine and dentistry. J Contemp Dent Pract. 2008;4:75–84.CrossRef Nogales CG, Ferrari PA, Kantorovich EO, Lage-Marques JL. Ozone therapy in medicine and dentistry. J Contemp Dent Pract. 2008;4:75–84.CrossRef
15.
go back to reference Isola G, Matarese M, Ramaglia L, Cicciù M, Matarese G. Evaluation of the efficacy of celecoxib and ibuprofen on postoperative pain, swelling, and mouth opening after surgical removal of impacted third molars: a randomized, controlled clinical trial. Int J Oral Maxillofac Surg. 2019;48(10):1348–54.CrossRef Isola G, Matarese M, Ramaglia L, Cicciù M, Matarese G. Evaluation of the efficacy of celecoxib and ibuprofen on postoperative pain, swelling, and mouth opening after surgical removal of impacted third molars: a randomized, controlled clinical trial. Int J Oral Maxillofac Surg. 2019;48(10):1348–54.CrossRef
16.
go back to reference Isola G, Matarese M, Ramaglia L, Iorio-Siciliano V, Cordasco G, Matarese G. Efficacy of a drug composed of herbal extracts on postoperative discomfort after surgical removal of impacted mandibular third molar: a randomized, triple-blind, controlled clinical trial. Clin Oral Investig. 2019;23:2443–53.CrossRef Isola G, Matarese M, Ramaglia L, Iorio-Siciliano V, Cordasco G, Matarese G. Efficacy of a drug composed of herbal extracts on postoperative discomfort after surgical removal of impacted mandibular third molar: a randomized, triple-blind, controlled clinical trial. Clin Oral Investig. 2019;23:2443–53.CrossRef
17.
go back to reference 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;75:51.e1–9.CrossRef 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;75:51.e1–9.CrossRef
18.
go back to reference Nogales CG, Ferreira MB, Lage-Marques JL, Antoniazzi JH. Comparison of the antimicrobial activity of three different concentrations of aqueous ozone on Pseudomonas aeruginosa, Staphylococcus aureus, and enterococcus faecalis – in vitro study. Rev Esp Ozonot. 2014;1:9–15. Nogales CG, Ferreira MB, Lage-Marques JL, Antoniazzi JH. Comparison of the antimicrobial activity of three different concentrations of aqueous ozone on Pseudomonas aeruginosa, Staphylococcus aureus, and enterococcus faecalis – in vitro study. Rev Esp Ozonot. 2014;1:9–15.
19.
go back to reference Gogulanathan M, Elavenil P, Gnanam A, Raja VB. Evaluation of fibrin sealant as a wound closure agent in mandibular third molar surgery— a prospective, randomized controlled clinical trial. Int J Oral Maxillofac Surg. 2015;44:871–5.CrossRef Gogulanathan M, Elavenil P, Gnanam A, Raja VB. Evaluation of fibrin sealant as a wound closure agent in mandibular third molar surgery— a prospective, randomized controlled clinical trial. Int J Oral Maxillofac Surg. 2015;44:871–5.CrossRef
20.
go back to reference Miočević M, O'Rourke HP, MacKinnon DP, Brown HC. Statistical properties of four effect-size measures for mediation models. Behav Res Methods. 2018;50:285–301.CrossRef Miočević M, O'Rourke HP, MacKinnon DP, Brown HC. Statistical properties of four effect-size measures for mediation models. Behav Res Methods. 2018;50:285–301.CrossRef
21.
go back to reference 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;7:1239–43.PubMedPubMedCentral 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;7:1239–43.PubMedPubMedCentral
22.
go back to reference Oikarinen K. Postoperative pain after mandibular third-molar surgery. Acta Odontol Scand. 1991;49:7–13.CrossRef Oikarinen K. Postoperative pain after mandibular third-molar surgery. Acta Odontol Scand. 1991;49:7–13.CrossRef
23.
go back to reference Wenqing X, Changqing W. Different efficiency of Ozonated water washing to inactivate salmonella enterica Typhimurium on green onions, grape tomatoes, and green leaf lettuces. J Food Sci. 2014;79:378–83.CrossRef Wenqing X, Changqing W. Different efficiency of Ozonated water washing to inactivate salmonella enterica Typhimurium on green onions, grape tomatoes, and green leaf lettuces. J Food Sci. 2014;79:378–83.CrossRef
24.
go back to reference Karaca H, Velioglu S. Ozone applications in fruit and vegetable processing. Food Rev Internat. 2007;23:91–106.CrossRef Karaca H, Velioglu S. Ozone applications in fruit and vegetable processing. Food Rev Internat. 2007;23:91–106.CrossRef
25.
go back to reference Chugh A, Singh S, Mittal Y, Chugh V. Submucosal injection of dexamethasone and methylprednisolone for the control of postoperative sequelae after third molar surgery: randomized controlled trial. Int J Oral Maxillofac Surg. 2018;47:228–33.CrossRef Chugh A, Singh S, Mittal Y, Chugh V. Submucosal injection of dexamethasone and methylprednisolone for the control of postoperative sequelae after third molar surgery: randomized controlled trial. Int J Oral Maxillofac Surg. 2018;47:228–33.CrossRef
26.
go back to reference Su N, Wang H, Zhang S, Liao S, Yang S, Huang Y. Efficacy and safety of bupivacaine versus lidocaine in dental treatments: a meta-analysis of randomised controlled trials. Int Dent J. 2014;64:34–45.CrossRef Su N, Wang H, Zhang S, Liao S, Yang S, Huang Y. Efficacy and safety of bupivacaine versus lidocaine in dental treatments: a meta-analysis of randomised controlled trials. Int Dent J. 2014;64:34–45.CrossRef
27.
go back to reference Taneja P, Pattni A, Pearson D. What's new in the management of post-operative pain in dentistry. SAAD Dig. 2015;31:3–7.PubMed Taneja P, Pattni A, Pearson D. What's new in the management of post-operative pain in dentistry. SAAD Dig. 2015;31:3–7.PubMed
28.
go back to reference Mantovani E, Arduino PG, Schierano G, Ferrero L, Gallesio G, Mozzati M, Russo A, Scully C, Carossa S. A split-mouth randomized clinical trial to evaluate the performance of piezosurgery compared with traditional technique in lower wisdom tooth removal. J Oral Maxillofac Surg. 2014;72:1890–7.CrossRef Mantovani E, Arduino PG, Schierano G, Ferrero L, Gallesio G, Mozzati M, Russo A, Scully C, Carossa S. A split-mouth randomized clinical trial to evaluate the performance of piezosurgery compared with traditional technique in lower wisdom tooth removal. J Oral Maxillofac Surg. 2014;72:1890–7.CrossRef
29.
go back to reference Bartuli FN, Luciani F, Caddeo F, DE Chiara L, DI Dio M, Piva P, Ottria L, Arcuri C. Piezosurgery vs high speed rotary Handpiece: a comparison between the two techniques in the impacted third molar surgery. Oral Implantol (Rome). 2013;6:5. Bartuli FN, Luciani F, Caddeo F, DE Chiara L, DI Dio M, Piva P, Ottria L, Arcuri C. Piezosurgery vs high speed rotary Handpiece: a comparison between the two techniques in the impacted third molar surgery. Oral Implantol (Rome). 2013;6:5.
30.
go back to reference 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:S222–7.CrossRef 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:S222–7.CrossRef
31.
go back to reference Koerner KR. The removal of impacted third molars. Principles and procedures. Dent Clin N Am. 1994;2:255–78. Koerner KR. The removal of impacted third molars. Principles and procedures. Dent Clin N Am. 1994;2:255–78.
32.
go back to reference Schober P, Bossers SM, Schwarte LA. Statistical significance versus clinical importance of observed effect sizes: what do P values and confidence intervals really represent? Anesth Analg. 2018;126:1068–72.CrossRef Schober P, Bossers SM, Schwarte LA. Statistical significance versus clinical importance of observed effect sizes: what do P values and confidence intervals really represent? Anesth Analg. 2018;126:1068–72.CrossRef
Metadata
Title
Influence of ozonized water on pain, oedema, and trismus during impacted third molar surgery: a randomized, triple blind clinical trial
Authors
José Cristiano Ramos Glória
Dhelfeson Willya Douglas-de-Oliveira
Larissa Doalla Almeida e Silva
Saulo Gabriel Moreira Falci
Cássio Roberto Rocha dos Santos
Publication date
01-12-2020
Publisher
BioMed Central
Published in
BMC Oral Health / Issue 1/2020
Electronic ISSN: 1472-6831
DOI
https://doi.org/10.1186/s12903-020-1029-5

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