caries management research & clinical application

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1 caries management research & clinical application

2 present dentistry It is a sad fact of life that every dentist is trained that if there is an area of decay in a tooth, the only way to treat this is to drill the decay out or amputate it, and then place a filling, which will need replacement at some time in the future; at worse, the tooth may have to be removed.

3 present dentistry

4 present dentistry

5 present dentistry

6 present dentistry

7 infection? let s amputate!

8 easy to apply + great results

9 dentistry can change peoples lives 1996; 11; ; 12; 10

10 caries reversal dull leathery shiny hard, remineralised

11 research in dental care Progression Hard Leathery Reversal Soft

12 caries diagnosis ~ diagnosis & evaluation; research results a basic guide to the DIAGNOdent values & The CSI DIAGNOdent Values extent of carious lesion white spot -> DV stain -> DV? visible on X-rays -> DV Visible on X-rays -> DV 10~19 20~24 25~29 > 30 confined to enamel CSI 2 at the edj CSI 3 1-2mm into dentine CSI 4 3+ mm into dentine CSI 5 Holmes J & Lynch E, 2001 (from Lussi A, Caries Research, 1999; 33, 297)

13 caries diagnosis Holmes J, 2007 (from Holmes J & Lynch E, 2001)

14 caries diagnosis Index Clinical Severity Index DIAGNOdent Reading Clinical Criteria Operative Care Treatment (seconds) Sessions required Protocol 0 Severity Index 0. Lesion arrested (defined as deemed to have had infected demineralised dentine or enamel where clinical remineralisation of the under lying dentine and enamel is considered to be complete) This scenario is where clinical remineralisation of the underlying dentine is considered to be complete with no infection remaining in dentine or enamel. No frosting in the fissure will be visible after drying. Varies due to stain uptake by remineralised tissue hard, shiny surface no frosting open fissure, O3 + glass ionomer or resin sealant combine ozone with air abrasion 1 x 60- second ozone cycles Single treatment session open lesion, remove any debris, O3, mineral wash, glass ionomer or resin sealant & OHI 1 Severity Index 1. Lesion deemed to be reversing (defined as deemed to have infected demineralised dentine or enamel that is reversing) This scenario is where clinical remineralisation of the underlying dentine is considered to be in the process of remineralising the demineralised dentine, but is not yet complete. The frosted enamel in the fissure (visible after drying) will be reducing. Varies due to stain uptake by remineralised tissue dried lesion appears frosted, white demineralis ation open fissure, O3 + glass ionomer or resin sealant combine ozone with air abrasion 1 x 60- second ozone cycles Single treatment session open lesion, remove any debris, O3, mineral wash, glass ionomer or resin sealant & OHI

15 caries diagnosis Index Clinical Severity Index DIAGNOdent Reading Clinical Criteria Operative Care Treatment (seconds) Sessions required Protocol 2 Severity Index 2. Lesion deemed to require fissure sealant with a preventative resin restoration (define this as deemed to have enamel caries confined to the enamel and NOT extending to the amelodentinal junction) dried lesion appears frosted, white demineralisation open lesion, remove debris, O3 + glass ionomer combine ozone with air abrasion 1 x 60- second ozone cycles Single treatment session open lesion, remove soft debris, O3, mineral wash, glass ionomer or resin sealant & OHI 3 Severity Index 3. Lesion deemed to require drilling and filling with a preventative resin restoration (define this as deemed to have enamel caries extending to the amelodentinal junction but not beyond into dentine) dried lesion appears frosted, white demineralisation open lesion, remove debris, O3 + glass ionomer combine ozone with air abrasion 1 x 60- second ozone cycles Single treatment session open lesion, remove soft debris, O3, mineral wash, glass ionomer or resin sealant & OHI 4 Severity Index 4. Lesion deemed to require drilling and filling (define this as deemed to have infected dentine extending less than one millimeter into dentine) dried lesion appears frosted, white enamel demineralisation, soft dentine open lesion, remove debris, O3 + glass ionomer combine ozone with air abrasion 1 x 60- second ozone cycles Single treatment session open lesion, remove soft debris, O3, mineral wash, glass ionomer & OHI 5 Severity Index 5. Lesion deemed to require drilling and filling (define this as deemed to have infected dentine extending one to two millimeters into dentine) dried lesion appears frosted, white enamel demineralisation, soft dentine, possible pulp exposure in deciduous teeth open lesion, remove debris, O3 + glass ionomer combine ozone with operativ e care 2 x 60- second ozone cycles Single treatment session open lesion fully, remove soft debris, saucerise lesion, O3, leave open to remineralise, use glass ionomers & OHI

16 caries diagnosis Index Clinical Severity Index DIAGNOdent Reading Clinical Criteria Operative Care Treatment (seconds) Sessions required Protocol 6 Severity Index 6. Lesion deemed to require drilling and filling (define this as deemed to have infected dentine extending two or more millimeters into dentine) dried lesion appears frosted, white enamel demineralisation, soft dentine, possible pulp exposure multiappointment & stage treatment protocol combine ozone with operative care second ozone cycles Multiple treatment sessions open lesion fully, remove soft debris, saucerise lesion, O3, leave open to remineralise, use glass ionomers & OHI 7 Severity Index 7. Lesion deemed to require drilling and filling (define this as deemed to have heavily infected dentine extending over 3 millimeters into dentine) dried lesion appears frosted, white enamel demineralisation, soft dentine, probable pulp exposure multiappointment & stage treatment protocol combine ozone with operative care second ozone cycles Multiple treatment sessions open lesion fully, remove soft debris, saucerise lesion, O3, leave open to remineralise, use glass ionomers & OHI 8 Severity Index 8. Lesion deemed to require drilling and filling (define this as deemed to have heavily infected dentine extending over 3 millimeters into dentine) over 90 reading is beyond the limits of the DIAGNOdent dried lesion appears frosted, white enamel demineralisation, soft dentine, probable pulp exposure multiappointment & stage treatment protocol combine ozone with operative care second ozone cycles Multiple treatment sessions open lesion fully, remove soft debris, saucerise lesion, O3, leave open to remineralise, use glass ionomers & OHI

17 ozone therapies in dental care early enamel caries enamel under acid attack enamel demineralises mineral loss leads to clinical changes O 3 eliminates bacteria & acids mineral applied wash onto enamel fuji7 applied to enamel fissures long-term fluoride release prevents debris impaction remineralised enamel > resistance alternative to fissure sealant fast easy to apply predictable

18 ozone therapies in dental care

19 ozone therapies in dental care

20 ozone therapies in dental care

21 ozone therapies in dental care

22 ozone therapies in dental care clinical examples the early carious lesion enamel demineralisation white spots

23 ozone therapies in dental care clinical examples the early carious lesion ~ treatment of occlusal decay enamel decay early demineralisation confined to enamel/edj example 1

24 No 1306 Clinical Reversal of Occlusal Pit and Fissure Carious Lesions (OPFCLs) Holmes J 1 and Lynch E 2. 1 Adentec & UKSmiles, Wokingham, Berkshire, UK 2 Health and Healthcare Group, School of Dentistry, Queen s University Belfast, Northern Ireland Introduction Recent reports in the UK national press have lead to an interest by the general public in ozone technologies. This study, Clinical Reversal of Occlusal Pit and Fissure Carious Lesions (OPFCLs) using Ozone in General Dental Practice was set up to assess the effects of the use of ozone on occlusal pit and fissure caries in a general dental practice. Aim The aim of this study was to observe and measure the Clinical Reversal, Stabilisation or Progression of Clinical Reversal of Occlusal Pit and Fissure Carious Lesions (OPFCLs) using Ozone in a General Dental Practice. Materials and Methods The data sets were obtained from 237 patients with 978 occlusal pit and fissure carious lesions (OPFCLs), who presented to UKSmiles, a general dental practice, near London, over a period from December 2001 through to the end of August 2002, and subsequently attended a 2-month recall. Each tooth was randomized and assigned to two groups; a, be treated with O 3 or b, left as a control. All surfaces to be measured were cleaned with the ProphyFlex (KaVo) and each lesion assigned an index number using a Clinical Severity Index (CSI) as shown in Table 1b. This Index value was recorded. Various indices have been used in past studies, and a Clinical Severity Index (CSI, Table 1), developed by Professor Edward Lynch (Queens University, Belfast) & Dr Julian Holmes (UKSmiles, Wokingham) was used to determine how long each lesion was to be treated with ozone. This treatment time varied from 0 seconds for the lowest (0) CSI score to 40 seconds with the highest (5) CSI score. The CSI used in this study was based on the Ekstrand index for clinical caries detection. The Ekstrand Index was modified to allow easy and fast indexing of lesions in a general dental practice environment, so that once this pilot study is completed, other general dental practices could send in data for an extended study using reproducible criteria. Table 1; Clinical Severity Index Table 2; DV & CSI Data Table 3 & 4; Changes in the DV & CSI Data Results - Statistics The mean DIAGNOdent (DV) and CSI values are shown in Table 2. The mean DV in the O 3 group decreased compared to baseline measurements (p < 0.01) showing remineralisation. There was no statistical difference between start DV s and finish DV f in the control group. There were statistically significant differences in the changes in DIAGNOdent readings between the treated lesions after an average of 2 months, and between the O 3 group / control group at the 2-month review (p < 0.001). The table shows that the O 3 group averaged DV s reading of 65 at the start and at recall, the O 3 group had a DV f average of 16. The control group averaged DV s reading of 63 at the start of the study period & at recall this changed to 66. The majority of the control lesions showed little improvement or signs of remineralisation. Discussion The Clinical Severity Index above was the primary outcome variable. Three Ozone treated lesions showed increased DIAGNOdent values at the recall visit. These lesions consisted of exposed dentine which had become darker in colour. In these lesions, it is postulated that the remineralisation process has led to an increase in the stain or colouration of the lesions. The DIAGNOdent is very sensitive to stains, which is why the cleaning protocol prior to DIAGNOdent assessment is so important. The results acquired from this ozone study mirror those from other clinical research trials in other research centres. By increasing the O 3 Tx time up to 40 seconds, the remineralisation observed has become more predictable. Conclusions Over 99% of the ozone treated primary occlusal fissure carious lesions had clinically reversed based on the clinical severity index and the DIAGNOdent readings (P<0.001). The control primary occlusal fissure carious lesions, which had not received any ozone treatment, did not significantly change. Patients love this system; it is pain free, fast, and they are happy to pay for this treatment modality References 1. Baysan A., Whiley RA., Lynch E. Antimicrobial effect of a novel ozonegenerating device on micro-organisms associated with primary root carious lesions in vitro. Caries Res. 2000; 34: Baysan A., Lynch E. and Grootveld M. The use of ozone for the management of primary root carious lesions. Quintessence Publishing Group 2001; Patients Attitudes to Managing Caries with Ozone. H.DOMINGO *, L. ABU- NABA'A, H. AL SHORMAN, C.SMITH, R. FREEMAN and E.LYNCH. (Health and Health Care Research Centre, School of Dentistry, Queen s University

25 No 2752 Introduction There is a great deal of interest by the general public in ozone technologies, following press reports of this new treatment modality for tooth decay. This study, Clinical Reversal of Occlusal Carious Lesions (OCLs) using Ozone in General Dental Practice is based on a previous study, Clinical Reversal of Pit & Fissure Carious Lesions, published in 2002 by Holmes J et al, with extended data. Aim The aim of this study was to observe and measure the Clinical Reversal, Stabilisation or Progression of Occlusal Carious Lesions (OCLs) using Ozone in a General Dental Practice. Materials and Methods The data sets were obtained from 376 patients with 2364 occlusal carious lesions (OCLs), who presented to UKSmiles, a general dental practice, near London, over a period from July 2001 through to the end of December All these patients have been reviewed for a minimum of 6 months. The early patients have now been followed for 18 months.(table 1) Each tooth was randomized and assigned to two groups; a, be treated with O3 or b, left as a control. All surfaces to be measured were cleaned with the ProphyFlex (KaVo) and each lesion assigned an index number using a Clinical Severity Index (CSI) as shown in Table 2. This Index value was recorded. Various indices have been used in past studies, and a Clinical Severity Index (Table 2), developed by Holmes et al, 2002 was used to determine treatment time with o2one. This treatment time varied from 0 seconds for the lowest (0) CSI score to 40 seconds with the highest (5) CSI score. The CSI used in this study is based on the Ekstrand index.the CSI & DIAGNOdent (KaVo) allow easy and fast indexing of lesions in a general dental practice environment, so that other general dental practices can contribute data for an extended European study using reproducible criteria. Results Statistics The increased data sets have confirmed the earlier study results published in 2002, with no change in the results. The mean DIAGNOdent (DV) and CSI values are shown in Table 3. The mean DV in the O3 group decreased compared to baseline measurements (p < 0.01) showing remineralisation. There was no statistical difference between start DVs and finish DVf in the control group. There were statistically significant differences in the changes in DIAGNOdent readings between the treated lesions after an average of 2 months, and between the O3 group / control group at the 2-month review (p < 0.001). The table shows that the O3 group averaged DVs reading of 65 at the start and at recall, the O3 group had a DVf average of 16. The control group averaged DVs reading of 63 at the start of the study period & at recall this changed to 66. The majority of the control lesions showed little improvement or signs of remineralisation. Clinical Reversal of Occlusal Carious Lesions (OCLs) Holmes J. Health and Healthcare Group, School of Dentistry, Queen s University Belfast, Northern Ireland Results Statistics (ctd) The CSI scores are shown in Table 4. The majority of lesions reversed from CSI 4 to 0 in the ozone group, when compared to the control group (p < 0.001). The control group overall showed no improvement. At the first assessment, 90% of all lesions for O3 Tx fall into categories 3, 4 & 5, & 67% of all lesions for O3 Tx fall into CSI groups 5 & 4. After O3 treatment, the CSI data shows 93% of the O3 Tx lesions falling into CSI 0 & 1. There is a clear shift in the distribution of DVs, to DV f in Table 4, showing a clear trend towards remineralisation. 61% of all lesions were assessed with a DVs of >50, compared to a DVf at recall where 97% of all lesions had changed to a DVf of <30. This finding is supported by earlier studies where the treatment time was limited to 10 or 20 seconds (1,2). Discussion The Clinical Severity Index has continued to prove a valuable assessment tool, and is now used in dental practices which offer ozone treatment in the UK. Three Ozone treated lesions showed increased DIAGNOdent values at the recall visit. These lesions consisted of exposed dentine which had become darker in colour. In these lesions, it is postulated that the remineralisation process has led to an increase in the stain or colouration of the lesions. The DIAGNOdent is very sensitive to stains, which is why the cleaning protocol prior to DIAGNOdent assessment is so important. The results acquired from this ozone study mirror those from other clinical research trials in other research centres. By increasing the O3 Tx time up to 40 seconds, the re-mineralisation observed has become more predictable. Conclusions Over 99% of the ozone treated occlusal fissure carious lesions had clinically reversed based on the clinical severity index and the DIAGNOdent readings (P<0.001). The control primary occlusal fissure carious lesions, which had not received any ozone treatment, did not significantly change. Patients who are offered this treatment modality, as an alternative to conventional amputation therapy have embraced this new technology. Research by Domingo H (2002) has shown there is little anxiety and fear associated with this treatment method, and it has wide application in the treatment of patients of all ages. Treatment is pain free, fast, and patients are happy to pay for this treatment modality References Baysan A., Whiley RA., Lynch E. Antimicrobial effect of a novel ozone-generating device on microorganisms associated with primary root carious lesions in vitro. J Caries Research 2000; 34: Domingo H, Abu-Naba'a L, Al Shorman H, Smith C, Freeman R & Lynch E. Patients Attitudes to Managing Caries with Ozone.. (Health and Health Care Research Centre, School of Dentistry, Queen s University Belfast, Northern Ireland.) J Dent Res, 2002 Holmes J & Lynch E, Clinical Reversal of Pit & Fissure Carious Lesions (Health and Health Care Research Centre, School of Dentistry, Queen s University Belfast, Northern Ireland.) J Caries Research 2002 Table 1; patient treatment/review Recall Review Patients Reviewed Table 2; CSI No. lesions O3 treated Table 3; DV & CSI Data No. lesions reversed % % % Table 4; O 3 Treatment DV & CSI Data Dr Julian Holmes, June 2003

26 ozone therapies in dental care clinical examples the early carious lesion ~ treatment of occlusal decay example 1

27 ozone therapies in dental care clinical examples the early carious lesion ~ treatment of occlusal decay

28 ozone therapies in dental care clinical examples the early carious lesion ~ treatment of occlusal decay

29 ozone therapies in dental care enamel & dentine caries caries extends through the EDJ O 3 eliminates bacteria & acids mineral applied wash onto enamel fuji7 applied to enamel fissures long-term fluoride release prevents debris impaction remineralised dentine amorphous alternative to tissue amputation fast easy to apply predictable

30 ozone therapies in dental care enamel & dentine caries

31 ozone therapies in dental care enamel & dentine caries

32 ozone therapies in dental care

33 ozone therapies in dental care

34 ozone therapies in dental care

35 ozone therapies in dental care

36 ozone therapies in dental care

37 ozone therapies in dental care

38 ozone therapies in dental care

39 ozone therapies in dental care

40 ozone therapies in dental care

41 ozone therapies in dental care

42 ozone therapies in dental care

43 research in dental care literature overview: Showed > 86% caries reversal at 24 months 10 seconds ozone applied BAYSAN 1,2 and E. LYNCH 1 Journal of Dental Research Restorative Dentistry and Gerodontology, Queen s University Belfast, Northern Ireland, 2Department of Adult Oral Health, St. Bart s and the Royal London School of Medicine and Dentistry, London, UK.

44 research in dental care ozone treatment of root caries objectives of this study: Holmes J. Clinical reversal of root caries using ozone, double-blind, randomised, controlled 18- month trial. Gerodontology 2003; 20: ~ to assess the efficacy of an ozone delivery system combined with the daily use of a remineralising toothpaste, mouthrinse and spray for the management of non- cavitated leathery primary root carious lesions (PRCL s) in an ageing patient group (>60, mean 70.8yrs, SD+ 6).

45 research in dental care results: the detail ~ Progression Hard Leathery Reversal Soft Holmes J showed that 3 months after ozone treatment (40 seconds) 69% of caries had reversed to hard from CSI 2. Re-treatment at 3, 6, 12 and 18 months, resulted in 100% of caries reversing to hard by the 18 month and 24 month reviews. It is difficult to hypothesise whether all caries would have reversed to hard without re-treatment, although Baysan et al showed that 81% of caries (CSI 1 or 2) had reversed to hard 3 months after a single 20-second ozone treatment.

46 Economic Savings Treating Root Caries with Ozone or Air Abrasion H. DOMINGO, J. HOLMES, L. ABU-NABA'A, H. AL SHORMAN, A. BAYSAN and R. FREEMAN Queen's University of Belfast, United Kingdom Introduction Ozone treatment has been shown to significantly arrests root carious lesions (1-4). However no direct time and cost comparison has been completed comparing Ozone treatment with conventional dental treatment methods. Aim To assess if a new technology in a dental practice (HealOzone 5, Fig.1) could reduce the treatment time and cost for treatment of primary root caries at the baseline treatment visit. Materials and Methods Ozone, produced by the HealOzone device was selected for a time comparison with either Air Abrasion (Fig.2 PrepStart, Danville, USA), and a glass ionomer filling material (Fig 3. FujiVII, GC Corp, Japan 6), or traditional drill and fill (D&F) procedures (using a conventional glass-ionomer cement) for the management of primary root caries (PRCL s) in an ageing patient group (>60, mean 70.8yrs, SD 7) in a general dental practice. A total of 68 subjects with 3 lesions each (204 PRCL s in total) were recruited. The lesions were randomly assigned into three groups; treatment with; 1.Ozone, or; 2. Air abrasion and filling (A&F), or; 3. Traditional drilling and filling (D&F). In groups 1 & 2 PRCL preparation was carried out without the need for local anaesthetics. All lesions were finished with hand instruments (excavators), before restoration with a glass ionomer filling material (FujiVII). This modified ART technique is the subject offurther research. Results and Discussion 64 subjects completed this study. There were no observed adverse events. The mean time required for ozone treatment was 40 seconds (SD 5 seconds) for each lesion. The mean time required for A&F 9 minutes (540 seconds (SD 90 seconds). The mean time required for D&F was 27 minutes (1620 seconds (SD 8 minutes)) (overall p < 0.01). Ozone treatment was faster than traditional D&F by a factor of 40 and faster than A&F by 21. Air abrasion decreased the mean time for cavity preparation by 4 times when compared to traditional rotary drills (67 seconds (SD 12) compared to 4.5 minutes (SD 1.75 minutes) (p < 0.05)). The cost* of the treatment was assessed. The average cost to treat a lesion with ozone was 6.90, with A&F, 13.90; and with D+F The potential NHS fee was assessed as The gross potential profit for Ozone T x 37.10, for AA and D&F *Assumes 3 lesions treated at same appointment, surgery costs of 60.00/hour & UK NHS Fee Scale (Schedule of Fees June 2003) Products Used Fig.1 The HealOzone device CurOzone Inc USA & KaVo GmbH Germany Fig.2 The PrepStart Danville Engineering USA Fig.3 FujiVII GC Corp Japan Conclusion The combination of modern technologies, such as air abrasion, with Ozone offer economic savings for dental practices and patients. Compared with conventional drilling and filling of root caries, Ozone treatment offers potential cost savings in the treatment of caries. References 1. Lynch E, Baysan A, Silwood C, Grootveld M. Therapeutic oxidising activity of a novel anti-bacterial ozone-producing device on primary root caries. Caries Res 1998; 32: Baysan A, Whiley R, Lynch E. Antimicrobial effects of a novel ozone generating device on micro-organisms associated with primary root carious lesions in-vitro. Caries Res 2000; 34: Baysan A, Lynch E. Clinical review of root caries using ozone. J Dent Res 2002; 81: 733 (Sp Issue). 4. Holmes J. Clinical reversal of root caries using ozone, double-blind, randomised, controlled 18-month trial. Gerodontology 2003; 20: HealOzone, CurOzone Inc USA & KaVo GmbH Germany. 6. FujiVII, GC Corp Japan.

47 At Baseline; research in dental care ~ research ~ Holmes J, 2004, IADR Abstract ART Atraumatic Restorative Care 60 subjects, each with 2 soft PRCL s. 1 lesion ART+Ozone ART, leaving pulp unexposed + 20 seconds ozone 10 (+2) minutes treatment time 1 lesion LA, & conventional drill&fill 11 pulp exposures requiring RCT 23 (+4) minutes treatment time At Recall; 56 subjects returned for recall All restorations scored alpha for all USPHS criteria recorded (filling present, margins, surface finish) additional 4 teeth required RCT Results; 25% of conventionally treated teeth needed RCT 0% of ART + Ozone treated teeth needed RCT Conclusion; ART + Ozone 1. reduces time 2. saves tooth tissue 3. maintains tooth vitality 4. no detrimental effect to USPHS assessment

48 At Baseline; research in dental care ~ research ~ Holmes J, 2004, IADR Abstract ART Atraumatic Restorative Care 60 subjects, each with 2 soft PRCL s. 1 lesion ART+Ozone ART, leaving pulp unexposed + 20 seconds ozone 10 (+2) minutes treatment time 1 lesion LA, & conventional drill&fill 11 pulp exposures requiring RCT 23 (+4) minutes treatment time At Recall; 56 subjects returned for recall All restorations scored alpha for all USPHS criteria recorded (filling present, margins, surface finish) additional 4 teeth required RCT Results; 25% of conventionally treated teeth needed RCT 0% of ART + Ozone treated teeth needed RCT Conclusion; ART + Ozone 1. reduces time 2. saves tooth tissue 3. maintains tooth vitality 4. no detrimental effect to USPHS assessment

49 combined therapies in dental care ~ enamel + dentine decay; initial presentation air abrasion preparation example 3

50 combined therapies in dental care ~ enamel + dentine decay aa presentation after hand-instrumentation

51 combined therapies in dental care ~ enamel + dentine decay enamel etch finished preparation

52 combined therapies in dental care ~ enamel + dentine decay fujivii placement 6-month assessment

53 combined therapies in dental care ~ enamel + dentine decay initial presentation #26 example 4

54 combined therapies in dental care ~ enamel + dentine decay after air abrasion #26 after ozone 40 seconds #26

55 combined therapies in dental care ~ enamel + dentine decay mineral wash application #26 ready to fill #26

56 combined therapies in dental care ~ enamel + dentine decay fujivii application #26 occlusion re-established #26

57 combined therapies in dental care example 5 barbara age 38 time to treat; 5 minutes

58 ozone therapies in dental care integrated treatment: ~ enamel + dentine decay example 7

59 ozone therapies in dental care integrated treatment: ~ enamel + dentine decay

60 ozone therapies in dental care ~ treatment for patients; Abigall; 7-month results Before O3 Tx; After O3 Tx; Abigall Summers Referring Dentist Oloph Granath, USA

61 ozone therapies in dental care ~ treatment results to date. Charlotte O 3 treatment started Before O Review , 18-months After O3 after the first application of O

62 combined therapies in dental care ~ treatment for patients with secondary teeth 3 months later 05/11/ /01/2003 Before O3 After O3 Victoria Age th January 2003 Review & Assessment

63 combined therapies in dental care ~ treatment for patients with secondary teeth Before O3 After O3 29/01/2003 results at 3 months Photographs Dr Rob Wain, UK

64 research in dental care Does ozone damage dental nerve / pulp tissue? Chou J, Boyd D, Tompkins G. Effect of Ozone Treatment on Interleukin Levels in Dental Pulp IADR Abstract 0036, 2005 Objective: To determine whether therapeutic levels of ozone stimulate production of the inflammatory cytokines interleukin-2 (IL-2) and interleukin-6 (IL-6) in healthy teeth. Conclusion: From the experiment, there was no evidence that ozone treatment stimulated an increase in the levels of IL-6 and IL-2 in healthy dental pulp. This suggests that ozone elicits negligible inflammatory responses (if not reduces levels of inflammation) when applied to healthy teeth, and may have potential for prophylactic treatment of patients with high caries risk.

65 ozone therapies in dental care enamel & dentine caries limitations of ozone cannot bring life to dead tissue

66 ozone therapies in dental care integration into routine dental care

67 ozone therapies in dental care ~ ozone integrated into routine dental care example 8

68 ozone therapies in dental care integrated treatment: Tofflemyre matrix band surrounds 4.5 after cavity preparation. Deepest caries has not been removed, attempting to prevent a need for root canal treatment. Circumference must be sealed with block-out resin (below) before ozone can be delivered to kill bacteria in the remaining carious layer. example 9 Photographs Dr Melvin Perlmutter

69 ozone therapies in dental care ~ treatment for patients with primary teeth example 10 jade, age 4, 11 months time to treat; 4 minutes

70 ozone therapies in dental care ~ treatment results to date example 11 Jake; 4 yrs old, attention disorder syndrome pre-tx: DIAGNOdent 89, soft dentine, in pain 20 seconds O 3 each tooth; Recall & review at 46 days post-tx: DIAGNOdent 36. hard dentine, no pain

71 research in dental care ~ research ~ Holmes J, 2004, IADR Abstract ART Atraumatic Restorative Care At Baseline; 60 subjects, each with 2 soft PRCL s. 1 lesion ART+Ozone ART, leaving pulp unexposed + 20 seconds ozone 10 (+2) minutes treatment time 1 lesion LA, & conventional drill&fill 11 pulp exposures requiring RCT 23 (+4) minutes treatment time At Recall; 56 subjects returned for recall All restorations scored alpha for all USPHS criteria recorded (filling present, margins, surface finish) additional 4 teeth required RCT Results; 25% of conventionally treated teeth needed RCT 0% of ART + Ozone treated teeth needed RCT Conclusion; ART + Ozone 1. reduces time 2. saves tooth tissue 3. maintains tooth vitality 4. no detrimental effect to USPHS assessment ART- application of research to other caries presentations Using research to extend the use of technology

72 ozone therapies in dental care ~ treatment for patients with primary teeth #1E #2E example 12 Darryl, Age 3, 6 months Time to treat; 5 minutes

73 combined therapies in dental care ~ treatment for patients with primary teeth 1 st Appointment. pulpotomy & GA parents refused Tx 2 nd Appointment - 6 months later ART & glass ionomer example 13 Beth, Age 4, 1 month 3 rd Appointment -18 months later glass ionomer lost, pain++ dentist has ozone - 60 seconds Tx glass ionomer transitional fill

74 combined therapies in dental care ~ treatment for patients with primary teeth Fuji VII example 13 1 st Appointment pulpotomy & GA Beth, Age 4, 1 month Hyper-mineralised tissue 4 th Appointment Pain free Tissue regeneration & remineralisation Tooth vital Space maintained for upper molar

75 combined therapies in dental care ~ enamel + dentine decay; ozone +ART example 14

76 combined therapies in dental care ~ treatment results to date. Victoria example 15 Dr Julian Holmes Victoria; 33. mesial decay repaired 12 years ago Area of demineralisation Ozone treated for 120 seconds, mineral wash applied

77 ozone therapies in dental care ~ treatment for patients Other patterns of decay treatment for failing abutments example 16

78 ozone therapies in dental care ~ treatment for patients Other patterns of decay treatment for failing abutments example 17

79 Masters of Progressive Care

Clinical and cost effectiveness of HealOzone for the treatment and management of dental caries. KaVo Dental Ltd., U.K.

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