Eficácia da ozonioterapia em pacientes ortodônticos: revisão sistemática

Abstract

Fixed orthodontic treatment makes it difficult to adequately control the bacterial biofilm. This fact predisposes the patient to an additional risk for gingival inflammation and caries. Ozone therapy has been proposed as an alternative to assist in the oral health of orthodontic patients due to its antimicrobial and anti-inflammatory properties, and its ability to induce tissue regeneration. Thus, the objective of this systematic review was to evaluate the effectiveness of ozonated water in decreasing gingival inflammation in orthodontic patients. An electronic search was performed in six electronic databases [PubMed (Medline), Scopus, Web of Science, Medline Complete (EBSCO), Cochrane (Database for Systematic Review), Cochrane (CENTRAL and Protocols)] and gray literature, without limitations year of publication or language, until June 2022. The primary outcome was decreased gingival inflammation, and secondary outcomes were decreased periodontal pocket depth (PD), dental plaque index (PI), gingival bleeding index (GBI), gingival index (GI), and biomarkers of inflammation in gingival clavicular fluid (GCF). The risk of bias was analyzed using the Cochrane Risk of Bias for Non- Randomized Controlled Trials (N-RCTs) (ROBINS-I) and Cochrane Risk of Bias for Randomized Controlled Trials (RCTs) (RoB2) tool. The certainty of evidence was assessed for the reported results through a narrative synthesis using the Grades of Recommendations, Assessment, Development and Evaluation (GRADE) approach. Five clinical studies were eligible for evaluation, four N-RCTs and one RCT. The studies pooled a total of 133 patients aged between 13 and 30 years. In the set of parameters evaluated in gingival inflammation, studies reported an association between irrigation with ozonized water and decreased gingival inflammation with very low certainty of evidence. Studies have demonstrated greater experience of PD control with low-evidence certainty. Most studies found an association between the decrease in PI, GBI, GI, and the biomarkers LDH, AST and MCP-1 in gingival crevicular fluid with very low certainty of evidence.