1. Charles W. Ruefenacht DDS NMD IBDM AAOT Dallas Texas April 11-13, 2013

3. Ozone for the treatment of root sensitivity A. Symptoms B. Anatomical base C. Etiology D. Treatment protocol with ozone

4. Symptoms

5. Sharp, immediate, transitory pain to 1. cold 2. heat 3. air 4. biting*

6. Anatomy and Etiology

7. Enamel: 98% inorganic parallel enamel rods of HA crystalline brittle not tough

8. DEJ: interphase layer 50:50 collagen/mineral (vol) ~ 150 microns thick binds brittle enamel w/ tough dentin shock absorber allows for toughness prevents crack propagation Physical properties of the dentin-enamel junction region. Urabe, Nakajima, Sano, Tagami. American Journal of Dentistry, Vol 13, No 3, June 2000, 129-135

9. SEM etched dentin

10. SEM Dentin Dentin: 50% mineral, 30% collagen 25k/mm @ DEJ 48k/mm @ pulpchamer 2.8 micron diameter @ pulp 0.8-1micron @ DEJ peritubular dentin: more highly mineralized odontoblast in each tubule

11. Martin Brannstrom: The Hydrodynamic Theory of Dential Pain: Sensation, Preparations, Cares and the Dentinal Crack. JOE 1986. Fluid movement through tubule stimulates the odontoblastic processes triggering pain fibers. 1. cold - outward 2. heat - compression 3. air - stretch, pain ends w/ desiccation.

12. 1. identify the correct tooth 2. 10-15 gamma 3. high speed suction about 3/4 inch away from surface 4. apply ozone for about 10 seconds and re-test. 5. repeat ozone application until sensitivity gone. 6. collect money Ozone Treatment

14. Treatment 1. turn off pain fibers with ozone 2. stop fluid flow with bondable resins and probably with ‘plugs’ due to remineralization.

15. Now you know more than most dentists.

16. Thanks!