Non-Cochrane · intervention · PM41595546
Oxygen-Based Adjunct Therapies in Periodontitis: A Systematic Review and Meta-Analysis Within the Framework of Hypoxia and Inflammation.
Kollmar Tobias, Schepers Markus, Nogueira Andressa V B, et al. · Biomedicines · 2025 · PubMed · doi:10.3390/biomedicines14010009
Findings
Population Patients with periodontitis
2 findings
| Adjunct ozone therapy (gaseous ozone, ozonated water, ozonated olive oil) to subgingival instrumentation | Subgingival instrumentation alone | Clinical attachment level (CAL) change from baseline to follow-up 1 to 3 months after initial treatment | SMD 0.53 [-0.14, 1.19] GRADE not reported 7 studies · 292 participants |
| Adjunct local oxygen therapy to subgingival instrumentation | Subgingival instrumentation alone | Clinical attachment level (CAL) | no estimate extracted No studies found 0 studies |
Included primary studies 33
Open in Studies| Study | Year | Also included by | Outcomes it informs here | Trial data |
|---|---|---|---|---|
| Patel 2012 Effect of subgingival application of topical ozonated olive oil in the treatment of chronic periodontitis: a randomized, controlled,… PMID:22976566 | 2012 | 3 other reviews | not stated | not extracted yet |
| Nambiar 2022 Comparison of Ozonated Olive Oil and Chlorhexidine Gel as an Adjunct to Nonsurgical Periodontal Therapy for the Treatment of Chronic… PMID:36110593 | 2022 | 2 other reviews | not stated | not extracted yet |
| Nardi 2020 Evaluation of Salivary Matrix Metalloproteinase (MMP-8) in Periodontal Patients Undergoing Non-Surgical Periodontal Therapy and Mouthwash… PMID:32932898 | 2020 | 2 other reviews | not stated | not extracted yet |
| Al Habashneh 2015 Ozone as an adjunct to conventional nonsurgical therapy in chronic periodontitis: a randomized controlled clinical trial. PMID:24665871 | 2015 | 1 other review | Clinical attachment level (CAL) change from baseline to follow-up | not extracted yet |
| Colombo 2021 Ozone Gel in Chronic Periodontal Disease: A Randomized Clinical Trial on the Anti-Inflammatory Effects of Ozone Application. PMID:34356480 | 2021 | 1 other review | not stated | not extracted yet |
| Gandhi 2019 Effectiveness of the adjunctive use of ozone and chlorhexidine in patients with chronic periodontitis. PMID:31814999 | 2019 | 1 other review | not stated | not extracted yet |
| Tete 2023 Efficacy Ozone Therapy in Reducing Periodontal Disease. PMID:36984255 | 2023 | 1 other review | not stated | not extracted yet |
| Ameyaroy 2020 Comparative evaluation of the effect of Ozone therapy and Photodynamic therapy in non-surgical management of Chronic periodontitis: A… PMID:33144773 | 2020 | this review only | not stated | not extracted yet |
| Burcea 2022 Clinical Assessment of the Hyperbaric Oxygen Therapy Efficacy in Mild to Moderate Periodontal Affections: A Simple Randomised Trial. PMID:35208561 | 2022 | this review only | not stated | not extracted yet |
| Chen 2002 Biological effects of hyperbaric oxygen on human severe periodontitis. PMID:12670118 | 2002 | this review only | not stated | not extracted yet |
| Chen 2012 Effects of hyperbaric oxygen on aggressive periodontitis and subgingival anaerobes in Chinese patients. PMID:23493978 | 2012 | this review only | not stated | not extracted yet |
| Dengizek 2019 Evaluating clinical and laboratory effects of ozone in non-surgical periodontal treatment: a randomized controlled trial. PMID:30673028 | 2019 | this review only | Clinical attachment level (CAL) change from baseline to follow-up | not extracted yet |
| Gaggl 2006 Local oxygen therapy for treating acute necrotizing periodontal disease in smokers. PMID:16579700 | 2006 | this review only | not stated | not extracted yet |
| Hayakumo 2013 Clinical and microbiological effects of ozone nano-bubble water irrigation as an adjunct to mechanical subgingival debridement in… PMID:22422082 | 2013 | this review only | Clinical attachment level (CAL) change from baseline to follow-up | not extracted yet |
| Issac 2015 Management of Chronic Periodontitis Using Subgingival Irrigation of Ozonized Water: A Clinical and Microbiological Study. PMID:26436042 | 2015 | this review only | not stated | not extracted yet |
| Katti 2013 Effect of Ozonised water on Chronic Periodontitis - A Clinical Study. PMID:24324309 | 2013 | this review only | not stated | not extracted yet |
| Kaur 2019 Efficacy of Ozonised Water and 0.2% Chlorhexidine Gluconate in the Management of Chronic Periodontitis when Used as an Irrigant in… PMID:31204324 | 2019 | this review only | not stated | not extracted yet |
| Kshitish 2010 The use of ozonated water and 0.2% chlorhexidine in the treatment of periodontitis patients: a clinical and microbiologic study. PMID:20930341 | 2010 | this review only | not stated | not extracted yet |
| Lombardo 2020 Hyperbaric oxygen therapy for the treatment of moderate to severe periodontitis: a clinical pilot study. PMID:33227833 | 2020 | this review only | not stated | not extracted yet |
| Mehrotra 2023 Clinical efficacy of ozonated water and photodynamic therapy in non-surgical management of chronic periodontitis: A clinico- microbial… PMID:37625764 | 2023 | this review only | not stated | not extracted yet |
| Nogueira-Filho 2010 Effects of hyperbaric oxygen therapy on the treatment of severe cases of periodontitis. PMID:20462143 | 2010 | this review only | not stated | not extracted yet |
| Pandya 2016 Comparative evaluation of two subgingival irrigating solutions in the management of periodontal disease: A clinicomicrobial study. PMID:29238139 | 2016 | this review only | not stated | not extracted yet |
| Ranjith 2022 Adjunctive benefit of ozonized water irrigation with mechanical debridement in the management of Stage III periodontitis: A randomized… PMID:34420261 | 2022 | this review only | Clinical attachment level (CAL) change from baseline to follow-up | not extracted yet |
| Rapone 2022 The Gaseous Ozone Therapy as a Promising Antiseptic Adjuvant of Periodontal Treatment: A Randomized Controlled Clinical Trial. PMID:35055807 | 2022 | this review only | Clinical attachment level (CAL) change from baseline to follow-up | not extracted yet |
| Sacco 2017 The treatment of periodontal disease using local oxygen-ozone DOI:10.4081/ozone.2016.6498 | 2017 | this review only | not stated | not extracted yet |
| Shoukheba 2014 The effects of subgingival application of ozonated olive oil gel in patient with localized aggressive periodontitis. A clinical and… DOI:10.1016/j.tdj.2014.04.001 | 2014 | this review only | Clinical attachment level (CAL) change from baseline to follow-up | not extracted yet |
| Shrivastava 2022 A randomised clinico-microbial trial evaluated the use of ozone as a supplement to scaling and root planing in the treatment of chronic… DOI:10.47750/pnr.2022.13.s06.169 | 2022 | this review only | not stated | not extracted yet |
| Skurska 2010 Evaluation of the influence of ozonotherapy on the clinical parameters and MMP levels in patients with chronic and aggressive periodontitis. PMID:21097444 | 2010 | this review only | not stated | not extracted yet |
| Tasdemir 2019 The effects of ozone therapy on periodontal therapy: A randomized placebo-controlled clinical trial. PMID:30739369 | 2019 | this review only | not stated | not extracted yet |
| Uraz 2019 Ozone application as adjunctive therapy in chronic periodontitis: Clinical, microbiological and biochemical aspects. PMID:30988877 | 2019 | this review only | not stated | not extracted yet |
| Vasthavi 2020 Evaluation of ozone as an adjunct to scaling and root planing in the treatment of chronic periodontitis: A randomized clinico-microbial… PMID:31983844 | 2020 | this review only | not stated | not extracted yet |
| Wandawa 2017 matched by author and year (probable) | NR | this review only | not stated | not extracted yet |
| Yilmaz 2013 Evaluation of the clinical and antimicrobial effects of the Er:YAG laser or topical gaseous ozone as adjuncts to initial periodontal… PMID:23741997 | 2013 | this review only | Clinical attachment level (CAL) change from baseline to follow-up | not extracted yet |
Overlap with other reviews
Reviews that include the same primary studies are not independent evidence. Shared counts match studies by PMID, DOI or NCT, and otherwise by author and year (a probable match). Only the non-Cochrane dental reviews have study lists, so overlap with Cochrane reviews is not counted yet.
Review question
| Element | Planned (methods) | Found (results) |
|---|---|---|
| Population | Subjects with periodontitis (at least 10 subjects; no periodontal therapy in preceding 6 months) | Periodontitis patients (n=34 studies) |
| Intervention | Adjunct oxygen therapy (ozone, HBOT, local oxygen) to subgingival instrumentation | Ozone (26 studies: gaseous, ozonated water, ozonated olive oil, ozonated sunflower oil); HBOT (6); local oxygen (1) |
| Comparison | Subgingival instrumentation only | SI alone; SI + chlorhexidine; SI + photodynamic therapy |
| Outcomes | CAL (primary; meta-analysis); PPD if CAL not available (narrative) | CAL; PPD; pooled SMD for CAL in ozone (7 RCTs, n=292) |
| Study designs | RCTs and prospective non-randomized controlled clinical trials | 34 randomized controlled or comparative clinical studies; 8 RCTs eligible for meta-analysis (7 ozone, 1 HBOT, 0 local oxygen) |
| Timing | Follow-up at least 1 month for meta-analysis | Follow-up 1 to 24 months; ozone meta-analysis 1 to 3 months |
AMSTAR 2 items
Two independent extractors rated each item. Their ratings are shown side by side because they have not been reconciled yet. The overall rating follows Shea et al. 2017: one critical flaw gives Low, more than one gives Critically Low.
| Item | Extractor A | Extractor B | Agree |
|---|---|---|---|
| 1Research question includes PICO components | Yes | Yes | yes |
| 2Protocol established before the reviewcritical | Partial Yes | No | no |
| 3Choice of study designs explained | No | No | yes |
| 4Comprehensive literature searchcritical | Partial Yes | Partial Yes | yes |
| 5Study selection in duplicate | Yes | Yes | yes |
| 6Data extraction in duplicate | No | No | yes |
| 7List of excluded studies with reasonscritical | No | No | yes |
| 8Included studies described in detail | Partial Yes | Partial Yes | yes |
| 9Risk of bias assessed satisfactorilycritical | RCT: Partial Yes · NRSI: No | NRSI: No · RCT: Partial Yes | no |
| 10Funding of included studies reported | No | No | yes |
| 11Appropriate meta-analysis methodscritical | RCT: Yes · NRSI: N/A | NRSI: N/A · RCT: Yes | no |
| 12Impact of risk of bias on the pooled results | No | No | yes |
| 13Risk of bias accounted for in interpretationcritical | Yes | Yes | yes |
| 14Heterogeneity explained | Yes | Yes | yes |
| 15Publication bias investigatedcritical | No | No | yes |
| 16Conflicts of interest reported | Yes | Yes | yes |
| Overall | Critically Low | Critically Low | yes |