Clinical and microbiological assessment of low frequency ultrasound therapy using ozonated water in the treatment of generalized periodontitis

The objective is to evaluate the clinical and microbiological effectiveness of incorporating low frequency ultrasound therapy using water containing dissolved ozone into the comprehensive treatment of moderate chronic generalized periodontitis (CGP). A prospective randomized controlled study was conducted involving 100 patients aged 37–59 with moderate CGP. All patients received standard basic therapy (professional hygiene and curettage of periodontal pockets), after which two groups of 50 people were formed using random sampling. In the main group, an additional course of low frequency ultrasound therapy was carried out (using the Stomaton MM device, 26.5 kHz, amplitude 40–55 µm) via gauze pads soaked in ozonated water (≈0.05 ppm), using a labile technique on the vestibular surface of the gums of the upper and lower jaws, 2 minutes per procedure; the course consisted of 10 daily treatments. In the control group, participants underwent a course of 10 daily static applications using the same wipes soaked in ozonated water, for 5 minutes each, without ultrasonic treatment. Clinical evaluation (OHI-S, Muhlemann – Cowell bleeding index, PMA (papillary-marginal-alveolar index), Russell periodontal index (PI) was performed at points T0, T1, T2, T3; microbiological examination of subgingival contents (OMH, periodontopathogens of the I/II order, Candida spp., resident microflora) – at points T0, T1, T2. By T1, both groups showed a significant decrease in inflammation indices (p<0.01). By T2, the clinical result in the main group remained stable and was significantly better than in the control group (p<0.05). After 6 months (T3), the clinical and index indicators in the main group remained significantly better than the baseline values and the control group (p<0.05). In the main group, OHM decreased from 8.6±0.4 to 4.8±0.5 lg CFU/ml by T1 and to 5.6±0.4 lg CFU/ml by T2, in the control group – from 8.5±0.5 to 6.5±0.4 and 7.2±0.5 lg CFU/ml, respectively (p<0.001). Combined therapy provided a deeper and more persistent reduction of periodontopathogens of the I/II order and Candida spp. with simultaneous growth of resident/stabilizing microflora. The inclusion of low frequency ultrasound therapy with ozonated water in the comprehensive treatment of moderate chronic periodontal disease provides a more pronounced and sustained clinical and microbiological improvement compared to applications of ozonated water without ultrasound exposure and can be considered a pathogenetically substantiated non pharmacological component of periodontal therapy.

1. Volkov A.G., Paramonova I.A., Kopetsky I.S., Nikolskaya I.A., Eremin D.A., Kabisova G.S., Mikhailova E.G., Pobozhyeva L.V. Prospects for the use of ultrasound therapy in combination with a drug with an antiseptic effect in the complex treatment of periodontitis // Medical Alphabet. – 2021. – No. 2. – P. 71–74.

2. Volkov A.G., Morozov D.I., Dikopova N.Zh., Olesov E.E., Sinyakov A.I. Clinical efficacy of ultraphonophoresis of Metrogyl Denta gel in moderate periodontitis // Russian Dental Journal. – 2021. – Vol. 25, No. 1. – P. 48–53.

3. Morozov D.I., Volkov A.G., Olesov E.E., Dikopova N.Zh., Trefilova Yu.A. Study of the effect of various methods of using Metrogyl Denta gel on the microbiota of periodontal pockets in periodontitis. – Russian Dental Journal. – 2021. – Vol. 25, No. 1. – P. 42–47.]

4. Volkov A.G., Mikhaleva I.N. Physical methods of treating periodontal diseases. – Problems of dentistry. – 2008. – P. 210.

5. Popov A.A., Volkov A.G., Olesov E.E., Dikopova N.Zh., Zaslavsky S.A. Comparative Microbiological Study of Metrogyl Denta Gel Applications in the Treatment of Periodontitis. – Dentistry for Everyone. – 2021. – No. 2 (95). – P. 14–17.

6. Kodzaeva Z.S., Daurova F.Yu., Tomaeva D.I., Volkov A.G., Dikopova N.Zh., Budina T.V. Combined use of an antimicrobial drug and physical apparatus therapeutic factors in periodontitis. – Russian Dental Journal. – 2022. – Vol. 26, No. 5. – P. 415–420.

7. Paramonova I.A., Volkov A.G., Dikopova N.Zh., Paramonov Yu.O., Akhmedbaeva S.S. Using Ultrasound in the Comprehensive Treatment of Periodontitis. – Russian Dental Journal. – 2021. – Vol. 25, No. 1. – P. 91–96.

8. Paramonova I.A., Volkov A.G., Dikopova N.Zh., Podporin M.S., Paramonov Yu.O., Nikolskaya I.A. Experimental study of the antibacterial efficacy of an antiseptic drug activated by ultrasound of different frequencies. Endodontics Today. – 2023. – Vol.21, No. 3. – P. 188–193. (In Russ.)

9. Mkhoyan G.R., Razumova S. N., Brago A. S. [et al.] The use of an Ozone Generator that Produces Ozone Using Ultraviolet Radiation for Ozonize the Contact Medium in the Treatment of Gingivitis of Young People. – Journal of International Dental and Medical Research. – 2022. – Vol. 15, No. 1. – P. 250–254.

10. Kislitsina A.V., Volkov A.G., Dikopova N.Zh., Akhmedbaeva S.S., Shishmareva A.L. Experience in using ozone therapy in the treatment of periodontitis in instrumental musicians. – Issues of Balneology, Physiotherapy, and Therapeutic Physical Culture. – 2017. – Vol. 94, No. 4. – P. 31–34.

11. Сlinical and experimental validation of the ozone therapy effectiveness in case of accidental exposure of the dental pulp / N.Z. Dikopova, A.G. Volkov, E.G. Margaryan [et al.] // New Armenian Medical Journal. – 2021. – Vol. 15, No. 1. – P. 77–84.

12. Akhmedbaeva S.S., Volkov A.G., Prikuls V.F., Tsareva T.V., Podporin M.S., Nikolskaya I.A., Kokova M.A. Clinical and laboratory evaluation of the antimicrobial effect of water ozonated with shortwave ultraviolet radiation on the microbiota of periodontal pockets in the complex treatment of periodontitis. – Medical Alphabet. – 2022. – No. 2. – P. 37–40.

13. Mkhoyan G.R., Razumova S.N., Volkov A.G., Dikopova N.Zh., Volovikov O.I., Akhmedbaeva S.S. Experience with Low-Frequency Ultrasound and Ozonated Contact Media for Plaque Removal in the Treatment of Catarrhal Gingivitis in Young Adults. – Russian Dental Journal. – 2021. – Vol. 25. – No. 2. – P. 145–150.

14. Mkhoyan G.R., Razumova S.N., Volkov A.G., Dikopova N.Zh., Ponomareva A.G., Podporin M.S., Brago A.S. The Effect of Dental Plaque Removal Using Low-Frequency Ultrasound and Ozonated Contact Environment on the Gingival Sulcus Microbiota in Chronic Catarrhal Gingivitis in Young Adults. – Medical Alphabet. – 2021. – No. 12. – P. 16–20.

15. Akhmedbaeva S.S., Volkov A.G., Dikopova N.Zh., Paramonova I.A., Paramosnov Yu.O. Ozone therapy and ultrasound in the complex treatment of periodontitis. – Russian Dental Journal. – 2020. – Vol. 24, No. 2. – P. 74–78.