The Potential of Ozone Therapy as an Adjunct to Periodontal Treatment in Diabetes Mellitus: A Biomarker Scoping Review.

Background: Periodontitis is a prevalent inflammatory disease and a critical complication in individuals with Diabetes Mellitus (DM). The bidirectional relationship between periodontitis and DM exacerbates systemic inflammation and complicates disease management. Ozone therapy (OT), with its antimicrobial and immunomodulatory properties, has emerged as a promising adjunctive treatment for periodontitis in individuals with DM, though it remains underexplored. This scoping review evaluates the effects of OT on biomarkers associated with DM, which may indirectly suggest its potential as a complementary therapy for periodontitis management in DM.

Methods: A comprehensive search of PubMed, Cochrane, Embase, LIVIVO, Scopus, Web of Science, and LILACS (up to March 2024) identified 38 studies: 19 involving individuals with DM and 19 using DM animal models.

Results: OT positively influenced biomarkers such as Malondialdehyde (MDA), Superoxide Dismutase (SOD), reduced Glutathione (GSH), Catalase (CAT), Total Antioxidant Status (TAS), and Total Oxidant Status (TOS). OT also modulated inflammatory markers (TNF-α, IL-1β, IL-6, IL-8, IL-10, and CRP) and regenerative biomarkers (bFGF, BMP-2, CD34, VEGF, PDGF) while improving glycated hemoglobin (HbA1c). This study represents the first review to explore the effects of OT on DM biomarkers and infer possible implications of these effects if used as an adjunct in the treatment of periodontitis associated with DM.

Conclusion: OT may complement conventional periodontal treatments in individuals with DM by modulating biomarkers linked to periodontal health. These insights may guide future clinical studies to validate OT's role in the treatment and establish standardized protocols for its application in periodontal management in DM.