Title	Inconclusive Effectiveness Of Healozone In Managing Pit And Fissure Caries
Clinical Question	How effective is ozone treatment in management of early occlusal pit and fissure caries compared to fissure sealants?
Clinical Bottom Line	There is currently no reliable evidence that application of ozone gas to the surface of decayed teeth stops or reverses the decay process. Furthermore, there is not enough evidence from published RCTs on which to judge the effectiveness of ozone for the management of occlusal pit and fissure caries comparatively with current restorative methods of managing early dental caries with sealants/restorations. (See Comments on the CAT below)
Best Evidence
PubMed ID Author / Year Patient Group Study type (level of evidence) 16707073 Brazzelli/2006 Five full-text reports and five studies published as abstracts met the inclusion criteria. The five full-text reports consisted of two randomised controlled trials (RCTs) assessing the use of HealOzone for the management of primary root caries and two doctoral theses of three unpublished randomised trials assessing the use of HealOzone for the management of occlusal caries. Systematic Review Key results One unpublished study did not show any significant benefits of HealOzone for the management of non-cavitated pit and fissure lesions in the permanent dentition. Adding ozone to a fissure sealant did not seem to produce better sealant retention in occlusal lesions extending 2–4 mm into dentine either.On the whole, there is not enough evidence from published RCTs on which to judge the effectiveness of ozone for the management of both occlusal caries. 15266519 Rickard/2004 Three trials were included, with a combined total of 432 randomised lesions (137 participants). Cochrane Systematic Review Key results The risk of bias in all included studies in the review appeared high. The analyses of all three studies were conducted at the level of the lesion, which is not independent of the person. Also, effective masking of outcome assessors and allocation concealment was unclear. For these reasons, pooling of data was not appropriate or attempted in this Cochrane study. Individual studies showed inconsistent effects of ozone on caries, across different measures of caries progression or regression.
Evidence Search	Pubmed: “Healozone” OR "Ozone"[Mesh] AND "Dental Caries"[Mesh]
Comments on The Evidence	Overall, the quality of the included studies of both systematic reviews was modest, with many of the included studies depending on findings produced by the DIAGNOdent and Electric Caries Meter-devices which have been found to have varying sensitivity and specificity values.There is also a fundamental need for more evidence of appropriate rigour and quality before there can be a conclusive evidence to support the use of ozone in mainstream primary dental care and be considered a viable alternative to current methods for the management and treatment of dental caries.
Applicability	On the whole, there is not enough evidence from published RCTs on which to judge the effectiveness of ozone for the management of occlusal caries, hence limiting the applicability of the studies to clinicians to recommend the usage of ozone treatment.
Specialty	(Public Health) (Endodontics) (General Dentistry) (Pediatric Dentistry) (Restorative Dentistry)
Keywords	Healozone, ozone, dental caries, preventive dentistry
ID#	277
Date of submission	11/11/2009
E-mail	Loke@uthscsa.edu
Author	Weiqiang Loke, DDS
Co-author(s)
Co-author(s) e-mail
Faculty mentor
Faculty mentor e-mail
Basic Science Rationale (Mechanisms that may account for and/or explain the clinical question, i.e. is the answer to the clinical question consistent with basic biological, physical and/or behavioral science principles, laws and research?) None available
Comments and Evidence-Based Updates on the CAT (FOR PRACTICING DENTISTS', FACULTY, RESIDENTS and/or STUDENTS COMMENTS ON PUBLISHED CATs) by Amir Hassan (San Antonio, TX) on 04/03/2012 A PubMed search on this topic was completed on April 2, 2012. The publications listed in the CAT are the most recent and the highest level of evidence related to this clinical question. by Abby Shannon (San Antonio, TX) on 09/30/2021 I conducted a search on PubMed in Sept 2021 and found a recent meta-analysis Matsuura (2021) PMID: 32999260 comparing direct pulp materials, specifically if Biodentine was statistically superior to MTA for direct pulp capping success. The study found no significant difference in direct pulp capping success for the two materials. The meta-analysis further supports the conclusions of this CAT. by Nicholas Dybdal-Hargreaves (San Antonio) on 10/21/2021 PradeepKumar et al (J. Endod. 47. PMID-33984375) performed an updated meta-analysis on this topic in 2021. They found that overall, CBCT imaging is still not a good diagnostic tool to identify vertical root fractures.