Abstract
Periodontal diseases, including gingivitis and periodontitis, are chronic inflammatory conditions of the teeth' supporting structures that can lead to progressive tissue destruction and loss if left untreated. Basic treatments like scaling and root planing, alone or combined with antimicrobial agents, are the standard of care. However, with the increasing prevalence of antibiotic resistance and the need for new ideas in therapy, adjunctive treatments like ozone therapy have gained attention. Ozone (O(3)), a triatomic oxygen molecule, is used because of its strong antimicrobial, anti-inflammatory, and regenerative activity and, hence, as a potential tool in periodontal therapy. This review of the use of ozone therapy in periodontal disease breaks down the multifaceted mechanism of ozone therapy, which includes the selective antimicrobial action against biofilm-associated pathogens, immunomodulatory effects on host cells, and stimulation of tissue repair. O(3) therapy disrupts microbial biofilms, enhances immune cell function, and promotes healing by activating Nuclear Factor Erythroid 2-Related Factor 2 (Nrf2) and Mitogen-Activated Protein Kinase (MAPK) signaling pathways that regulate oxidative stress, inflammation, and apoptosis. Additional findings include its ability to upregulate growth factors and extracellular matrix proteins, which is significant for periodontal tissue regeneration. This review also discusses the application of O(3) therapy in periodontal cell lines, emphasizing its impact on cell viability, proliferation, and differentiation. Advances in periodontal regenerative techniques, combined with the antimicrobial and healing properties of O(3), have demonstrated significant clinical benefits. Challenges, including the need for standardized dosages, effective delivery systems, and long-term studies, are also addressed to ensure safe and effective clinical integration. O(3) therapy, with its dual antimicrobial and regenerative capabilities, offers an innovative adjunctive approach to periodontal treatment. Future research focusing on optimized protocols and evidence-based guidelines is essential to fully realize its potential in enhancing periodontal health and improving patient outcomes.