Conservative Management of Almost Cariously Exposed Pulpal Lesions Using Ozone

Objectives: Traditional management of symptomatic teeth with deep carious lesions almost reaching the pulp has involved removing the infected dentine which can be associated with increased postoperative sensitivity and/or root canal therapy (RCT). Ozone is a very powerful antimicrobial. This study assessed pain VAS scores and need for RCT after use of a traditional caries removal and restoration method or after a conservative ozone method of managing deep caries and restoration.
Methods: After ethics approval 26 subjects consented for random allocation to receive either traditional (n=13, 6 male, 7 female, mean age 24.5±2.4 years) or ozone (n=13, 6 male, 7 female, mean age 23.9±1.6 years) methods. The ozone method only differed from the traditional method by leaving the deep leathery caries on the pulpal floor before treating this with 10 seconds of ozone from the healozone X4 (Curozone, Germany). A conventional glass ionomer cement (Riva Self Cure High Viscosity, SDI) was placed followed by amalgam in each cavity. The pain VAS score was recorded before treatment and after 24 hours.
Results: The pain VAS score for subjects with the traditional treatment was 8.1 (±0.8) before treatment and 6.2 (±1.9) after 24 hours, whilst these were 8.0 (±0.7) and 0.5 (±0.5) for the ozone treated subjects. After 6 months, 6 subjects required RCT from the traditional management group whilst no subject required RCT in the ozone group. ANOVA showed a significant difference between groups in terms of VAS scores of pain after 24 hours of treatment (p<.0001) and the need for RCT after 6 months (p=.004). Ozone treatment was associated with less pain and less need for RCT.
Conclusions: Ozone treatment of symptomatic teeth with deep carious lesions, almost reaching the pulp, shows promise for a more conservative approach to treat deep caries, as well as being associated with less postoperative sensitivity and less need for RCT compared to a traditional management method.