Comparison of ozone therapy and antimicrobial photodynamic therapy in periodontitis: A randomized clinical trial.

Background: This randomized clinical trial evaluated the comparative efficacy of ozone therapy and ICG-mediated antimicrobial photodynamic therapy as adjunctive to scaling and root planing in the management of periodontitis, by assessing clinical outcomes, inflammatory biomarkers, specifically interleukin-1β (IL-1β) and Pentraxin-3 (PTX-3), and microbial load via quantitative PCR. Methods: This is a parallel-arm, single-blinded, randomized controlled trial that included 36 patients with Stage III Grade B periodontitis, allocated randomly to three groups. Group 1 {Scaling and Root planing (SRP)}, Group 2 {SRP + Ozone Therapy (OT}), and Group 3 {SRP + Antimicrobial Photodynamic Therapy (aPDT)}. Clinical parameters, biochemical markers, and microbial count were recorded at baseline, 1 month, and 3 months. Result: The change in Plaque Index (PI), Gingival Index (GI), Probing Pocket Depth (PPD), and Clinical Attachment Level (CAL) from baseline to 1 month and from baseline to 3 months was significantly higher in the SRP + OT group (p < 0.001). Reduction in the microbial count of Porphyromonas gingivalis (Keystone pathogen) (Mean difference = -0.70, p < 0.001) and Tannerella forsythia (-0.51, p < 0.001), whereas SRP + aPDT provided superior suppression for Fusobacterium nucleatum (-0.76, p < 0.001) and Prevotella intermedia (0.40, p < 0.001). No meaningful difference was observed between the two adjuncts for Treponema denticola (p = 0.994). Conclusion: All treatment modalities resulted in significant improvements in all the parameters over time. However, SRP + Ozone Therapy consistently achieved the improvement across all parameters, when compared to SRP alone or SRP with aPDT.