Clinical Reversal of Occlusal Pit and Fissure Carious Lesions (OPFCLs)

Ozone has been shown to clinically reverse carious lesions in previous studies. This study aimed to assess a single 20-second dose of ozone to manage primary occlusal pit and fissure carious lesions in a general dental practice over a 24-month time period. Treatment of the carious lesion consisted of thorough prophylaxis of the occlusal surface, treatment with ozone or compressed air for 20 seconds, and the application to all treated teeth of a remineralising wash. All lesions and teeth were exposed to remineralising products from a standard dentifrice and brush throughout the 24month study period. Objective: To assess the effect of an ozone delivery system, combined with the daily use of a remineralising patient kit, on the clinical severity of non-cavitated primary occlusal pit and fissure caries carious lesions (OPFCLs), in a young population group. Design: A total of 106 subjects, (age range 20 – 29, mean + SD, 24.3 + 3.7 years), each with at least two OPFCLs, were recruited. Carious lesions were evaluated with a validated caries severity index (the CSI) and lesions in the CSI3 index were selected and were clinically assessed with the DIAGNOdent. The lesions in each subject were randomly assigned for treatment with ozone or no ozone (compressed air), in a double blind study design, in a general dental practice. Subjects were recalled 3, 6, 12, 18 and 24 months. Lesions were clinically re-assessed with the DIAGNOdent and reevaluated with the CSI at each visit. Results: There were no observed adverse events in the ozone-treated group. In the control group, one subject was dropped from the study at 18 months as the control lesion had become worse, and the subject presented with pain (this tooth was treated with ozone, cleaned and conventionally filled). Immediately after treatment, the DIAGNOdent readings were recorded. In the control lesion group, there was no change in the DvT0a values. In the lesions that were treated with ozone – ie the test lesions, there was an immediate decrease in the DvT0a values, with 86% (91 lesions) changing from 20-24 Dv group, to the 10-19 Dv group, and 14% (15 lesions) showing no change – ie they remained in the 20-24 Dv group. After 3 months, in the ozone treated group, 91 OPFCLs (86%) had reversed from CSI3 to CSI2&1 and none had deteriorated, whilst in the control group, 6 OPFCLs (6%) had become worse (CSI4) (p < 0.01), and 2 (2%) had reversed (CSI1&2). At the 6-month recall, in the ozone-treated group, 17 OPFCLs (16%) remained static at CSI3, the remaining 88 (84%) OPFCLs remained reversed at CSI1&2, whilst in the control group, 9 OPFCLs had become worse (9%) and one had arrested and reversed (p < 0.01). At 12 months, in the ozone treated group 79 (79%) remained in CSI1&2, 20 (20%) were recorded as CSI3, and 1 lesion (1%) was recorded as CSI4. In the control group 17 (17%) of the OPFCLs had progressed from CSI3 to CSI4, i.e. became worse, 83 OPFCLs (83%) remained in CSI3 (p < 0.01). At the 18-month recall, 69 (73%) of ozone treated OPFCLs remained in CSI2&1, 23 (24%) in CSI3, and 3 (3%) had become worse (CSI4), whilst in the control group, 23 lesions (24%) of the OPFCLs had worsened from CSI3 to CSI4 (p < 0.01), 72 (76%) OPFCLs remained in CSI3 (p < 0.01). After 24 months, and at the study end, 43 (58%) of ozone treated OPFCLs remained in CSI2&1, 26 (35%) in CSI3, and 5 (7%) had become worse (CSI4); in the control group, 38 lesions (51%) of the OPFCLs had worsened from CSI3 to CSI4 (p < 0.01), 36 (49%) OPFCLs remained in CSI3 (p < 0.01). Conclusions: Non-cavitated OPFCLs of CSI3 or less can be managed non-operatively with ozone and remineralising products. This study, when viewed in terms of the Holmes J 2003 Root Caries study, illustrates that a single dose of ozone is not an effective treatment for all carious lesion types, and that an alternative treatment protocol may be to re-treat with ozone at regular intervals. However, ozone treatment is an effective alternative to conventional "drilling and filling". 1. HealOzone, KaVo GmbH Germany; 2. Remineralising Patient Kit, CurOzone Inc, Canada; 3. CSI – Clinical Severity Index, Lynch E and Holmes J, Arresting Occlusal Fissure Caries Using Ozone. AADR Abstract no.678; 2003; 4. Holmes J. Clinical Reversal of Occlusal Pit and Fissure Caries Using Ozone. The First Pan-European Festival of Oral Sciences, Cardiff, Wales, UK. Abstract no 431; 2002 and J Dent Res 82: C-535; 2003; 5. DIAGNOdent, KaVo GmbH Germany; 6. Holmes J. Clinical Reversal of Root Caries Using Ozone, double-blind, randomised, controlled 18-month Trial. Gerodontology 2003: 20 (2): 106-114.