Skip to main content

Thank you for visiting nature.com. You are using a browser version with limited support for CSS. To obtain the best experience, we recommend you use a more up to date browser (or turn off compatibility mode in Internet Explorer). In the meantime, to ensure continued support, we are displaying the site without styles and JavaScript.

  • Review
  • Published:

Ozonated water as an irrigant in disinfecting root canal systems - a systematic review

Evidence-Based Dentistry (2022)Cite this article

Abstract

Aim To evaluate the efficacy of ozonated water as an irrigant in disinfection of the root canal system.

Materials and methods This systematic review was conducted according to PRISMA guidelines and methodological studies were assessed through the Cochrane Risk of Bias tool. All studies on extracted human teeth using ozonated water were considered for the study, whereas ex vivo studies, studies on animal dentition and studies which were published in languages other than English were excluded from the study. The search was carried out on various databases such as PubMed, Google Scholar and ScienceDirect within the last 15 years. The assessment of quality of the studies was performed under the following: 1) size of sample; 2) control group; 3) standardisation of procedure; 4) statistical analysis performed; 5) risk of bias.

Results There were a total of 154 study results, out of which duplicates and full-text analysis were excluded. A total of seven studies were included in the systematic review. The results in one study by Cardoso et al. showed ozonated water was better at reducing microbial counts, while two other studies demonstrated the difference in reducing microbial counts when comparing ozonated water against other irrigants. The remaining four studies concluded that ozonated water did not perform better as compared to the other irrigants such as sodium hypochlorite and chlorhexidine.

Discussion It could be concluded that ozonated water is not a better disinfecting irrigant than sodium hypochlorite and chlorhexidine in the disinfection of the root canal system; however, it had an almost comparable level of disinfection.

This is a preview of subscription content, access via your institution

Access options

Buy this article

  • Purchase on Springer Link
  • Instant access to full article PDF
Buy now

Prices may be subject to local taxes which are calculated during checkout

Fig. 1

Similar content being viewed by others

References

  1. Filippi A. The effects of ozonized water on epithelial wound healing (in German). Dtsch Zahnärztl Z 2001; 56: 104-108.

  2. Hubbezoglu I, Zan R, Tunc T, Sumer Z. Antibacterial efficacy of aqueous ozone in root canals infected by Entero-coccus faecalis. Jundishapur J Microbiol 2014; DOI: 10.5812/jjm.11411.

  3. Nagayoshi M, Kitamura C, Fukuizumi T, Nishihara T, Terashita M. Antimicrobial effect of ozonated water on bacteria invading dentinal tubules. J Endod 2004; 30: 778-781.

  4. Zehnder M. Root canal irrigants. J Endod 2006; 32: 389-398.

  5. Higgins J P, Altman D G, Gøtzsche P C et al. Cochrane Bias Methods Group; Cochrane Statistical Methods Group. The Cochrane Collaboration's tool for assessing risk of bias in randomised trials. BMJ 2011; DOI: 10.1136/bmj.d5928.

  6. Page M J, McKenzie J E, Bossuyt P M et al. The PRISMA 2020 statement: an updated guideline for reporting systematic reviews. BMJ 2021; DOI: 10.1136/bmj.n71.

  7. Pinherio S, Silva C, Silva L et al. Antimicrobial efficacy of 2.5% sodium hypochlorite, 2% chlorhexidine, and ozonated water as irrigants in mesiobuccal root canals with severe curvature of mandibular molars. Eur J Dent 2018; 12: 94-99.

  8. Zan R, Alacam T, Hubbezoglu I, Tunc T, Sumer Z, Alici O. Antibacterial Efficacy of Super-Oxidized Water on Enterococcus faecalis Biofilms in Root Canal. Jundishapur J Microbiol 2016; DOI: 10.5812/jjm.30000.

  9. Goztas Z, Onat H, Tosun G, Sener Y, Hadimli H H. Antimicrobial effect of ozonated water, sodium hypochlorite and chlorhexidine gluconate in primary molar root canals. Eur J Dent 2014; 8: 469-474.

  10. Estrela C, Estrela C R, Decurcio D A, Hollanda A C, Silva J A. Antimicrobial efficacy of ozonated water, gaseous ozone, sodium hypochlorite and chlorhexidine in infected human root canals. Int Endod J 2007; 40: 85-93.

  11. Huth K C, Quirling M, Maier S et al. Effectiveness of ozone against endodontopathogenic microorganisms in a root canal biofilm model. Int Endod J 2009; 42: 3-13.

  12. Cardoso MG, de Oliveira L D, Koga-Ito C Y, Jorge A O. Effectiveness of ozonated water on Candida albicans, Enterococcus faecalis, and endotoxins in root canals. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2008; DOI: 10.1016/j.tripleo.2007.10.006.

  13. Baysan A, Lynch E. the use of ozone in dentistry and medicine. Prim Dent Care 2005; 12: 47-52.

  14. Hems R S, Gulabivala K, Ng Y L, Ready D, Spratt D A. An in vitro evaluation of the ability of ozone to kill a strain of Enterococcus faecalis. Int Endod J 2005; 38: 22-29.

  15. Lezcano I, Rey R P, Gutierrez M S, Baluja C, Sanchez E. Ozone inactivation of microorganisms in water. Gram positive Bacteria and yeast. Ozone Sci Eng 2001; 23: 183-187.

  16. Mohammadi Z, Shalavi S, Soltani M K, Asgary S. Properties and Applications of Ozone in Endodontics: An Update. Iran Endod J 2013; 8: 40-43.

  17. Azarpazhooh A, Limeback H. The application of ozone in dentistry: a systematic review of literature. J Dent 2008; 36: 104-116.

Download references

Acknowledgements

This review has not been registered yet.

Author information

Authors and Affiliations

  1. Nitte (Deemed to be University), AB Shetty Memorial Institute of Dental Sciences (ABSMIDS) Department of Conservative Dentistry and Endodontics, Mangalore, India

    Nihar Shetty, Tony Mathew, Aditya Shetty, Mithra N. Hegde & Shruthi Attavar

Authors
  1. Nihar Shetty
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Tony Mathew
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Aditya Shetty
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Mithra N. Hegde
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Shruthi Attavar
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

Nihar Shetty conceived and designed the analysis, and wrote the paper. Tony Mathew conceived and designed the analysis, wrote the paper and is corresponding author of the study. Aditya Shetty collected the data. Mithra N. Hedge collected results from the data. Shruthi Attavar performed the analysis on results of the data collected.

Corresponding author

Correspondence to Tony Mathew.

Ethics declarations

The authors declare no conflicts of interest.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Shetty, N., Mathew, T., Shetty, A. et al. Ozonated water as an irrigant in disinfecting root canal systems - a systematic review. Evid Based Dent (2022). https://doi.org/10.1038/s41432-022-0800-7

Download citation

  • Received:

  • Accepted:

  • Published:

  • DOI: https://doi.org/10.1038/s41432-022-0800-7

Search

Advanced search

Quick links