Non-Cochrane · intervention · PM42641047
Efficacy of Ozonated Gels and Oils As Adjunctive or Monotherapy in Periodontitis: A Systematic Review and Meta-Analysis of Randomized Controlled Trials.
Bahrami Mahdi, Etemadi Mahsa, Abrishami Reyhaneh, et al. · Clinical and experimental dental research · 2026 · PubMed · doi:10.1002/cre2.70439
Findings
Population Patients with periodontitis
37 findings
| Ozonated gel or oil as adjunct to subgingival instrumentation | Subgingival instrumentation alone (or with placebo) | Probing pocket depth (PPD) 12 weeks follow-up · Dental clinic, periodontitis treatment · Subgroup: 12 weeks follow-up | MD -0.683 [-0.847, -0.520] GRADE not reported Studies not reported |
| Ozonated gel or oil as adjunct to subgingival instrumentation | Subgingival instrumentation alone (or with placebo) | Plaque index (PI) 12 weeks follow-up · Dental clinic, periodontitis treatment · Subgroup: 12 weeks follow-up | SMD 0.028 [-0.362, 0.157] GRADE not reported Studies not reported |
| Ozonated gel or oil as adjunct to subgingival instrumentation | Subgingival instrumentation alone (or with placebo) | Bleeding on probing (BoP) 4 to 12 weeks follow-up · Dental clinic, periodontitis treatment · Random-effects model | SMD -0.286 [-1.590, 1.018] GRADE not reported 6 studies |
| Ozonated gel or oil as adjunct to subgingival instrumentation | Subgingival instrumentation alone (or with placebo) | Bleeding on probing (BoP) 4 to 12 weeks follow-up · Dental clinic, periodontitis treatment · Sensitivity: leave-one-out excluding Nardi 2020 | SMD -0.765 [-1.419, -0.112] GRADE not reported 5 studies |
| Ozonated gel or oil as adjunct to subgingival instrumentation | Subgingival instrumentation alone (or with placebo) | Plaque index (PI) 4 to 12 weeks follow-up · Dental clinic, periodontitis treatment | SMD -0.222 [-0.535, 0.091] GRADE not reported 6 studies |
| Ozonated gel or oil as adjunct to subgingival instrumentation | Subgingival instrumentation alone (or with placebo) | Probing pocket depth (PPD) 4 to 12 weeks follow-up · Dental clinic, periodontitis treatment | MD -0.780 [-1.028, -0.531] GRADE not reported 8 studies |
| Ozonated gel or oil as adjunct to subgingival instrumentation | Subgingival instrumentation alone (or with placebo) | Gingival index (GI) 4 to 12 weeks follow-up · Dental clinic, periodontitis treatment | SMD -0.922 [-2.180, 0.336] GRADE not reported 3 studies |
| Ozonated gel or oil as adjunct to subgingival instrumentation | Subgingival instrumentation alone (or with placebo) | Bleeding on probing (BoP) 4 to 12 weeks follow-up · Dental clinic, periodontitis treatment · Sensitivity: fixed-effects model | SMD 0.343 [-0.008, 0.693] GRADE not reported 6 studies |
| Ozonated gel or oil as adjunct to subgingival instrumentation | Subgingival instrumentation alone (or with placebo) | Clinical attachment level (CAL) 4 to 12 weeks follow-up · Dental clinic, periodontitis treatment | MD -0.457 [-0.727, -0.187] GRADE not reported Studies not reported |
| Ozonated gel or oil as adjunct to subgingival instrumentation | Subgingival instrumentation alone (or with placebo) | Clinical attachment level (CAL) 12 weeks follow-up · Dental clinic, periodontitis treatment · Subgroup: 12 weeks follow-up | MD -0.473 [-0.935, -0.01] GRADE not reported Studies not reported |
| Ozonated gel or oil as adjunct to subgingival instrumentation | Chlorhexidine (CHX) gel as adjunct to subgingival instrumentation | Plaque index (PI) 4 to 12 weeks follow-up · Dental clinic, periodontitis treatment · Table 3 value (differs from text and Figure 3) | SMD -0.013 [-0.321, 0.295] GRADE not reported Studies not reported |
| Ozonated gel or oil as adjunct to subgingival instrumentation | Chlorhexidine (CHX) gel as adjunct to subgingival instrumentation | Probing pocket depth (PPD) 12 weeks follow-up · Dental clinic, periodontitis treatment · Subgroup: 12 weeks follow-up | MD -0.026 [-0.167, 0.115] GRADE not reported Studies not reported |
| Ozonated gel or oil as adjunct to subgingival instrumentation | Chlorhexidine (CHX) gel as adjunct to subgingival instrumentation | Probing pocket depth (PPD) 4 to 12 weeks follow-up · Dental clinic, periodontitis treatment · Meta-regression on follow-up duration, ozone vs CHX | Meta-regression coefficient (follow-up duration) 0.0176 GRADE not reported Studies not reported |
| Ozonated gel or oil as adjunct to subgingival instrumentation | Chlorhexidine (CHX) gel as adjunct to subgingival instrumentation | Plaque index (PI) 4 to 12 weeks follow-up · Dental clinic, periodontitis treatment | SMD -0.135 [-0.451, 0.180] GRADE not reported 4 studies |
| Ozonated gel or oil as adjunct to subgingival instrumentation | Chlorhexidine (CHX) gel as adjunct to subgingival instrumentation | Clinical attachment level (CAL) 4 to 12 weeks follow-up · Dental clinic, periodontitis treatment | MD 0.277 [-0.209, 0.763] GRADE not reported Studies not reported |
| Ozonated gel or oil as adjunct to subgingival instrumentation | Chlorhexidine (CHX) gel as adjunct to subgingival instrumentation | Plaque index (PI) 12 weeks follow-up · Dental clinic, periodontitis treatment · Subgroup: 12 weeks follow-up | SMD -0.182 [-0.520, 0.157] GRADE not reported Studies not reported |
| Ozonated gel or oil as adjunct to subgingival instrumentation | Chlorhexidine (CHX) gel as adjunct to subgingival instrumentation | Gingival index (GI) 4 to 12 weeks follow-up · Dental clinic, periodontitis treatment · Table 3 value (differs from text and Figure 4) | SMD -0.163 [-0.479, 0.152] GRADE not reported Studies not reported |
| Ozonated gel or oil as adjunct to subgingival instrumentation | Chlorhexidine (CHX) gel as adjunct to subgingival instrumentation | Gingival index (GI) 4 to 12 weeks follow-up · Dental clinic, periodontitis treatment | SMD -0.043 [-0.407, 0.322] GRADE not reported 3 studies |
| Ozonated gel or oil as adjunct to subgingival instrumentation | Chlorhexidine (CHX) gel as adjunct to subgingival instrumentation | Probing pocket depth (PPD) 4 to 12 weeks follow-up · Dental clinic, periodontitis treatment | MD -0.009 [-0.127, 0.108] GRADE not reported 6 studies |
| Ozonated gel or oil as adjunct to subgingival instrumentation | Chlorhexidine (CHX) as adjunct to subgingival instrumentation | Sulcus bleeding index (SBI) Short-term follow-up, 4 to 12 weeks (most studies 12 weeks) · Random-effects | -5.241 [-8.42, -2.062] GRADE not reported 4 studies |
| Ozonated gel or oil as monotherapy | CHX monotherapy | Probing pocket depth (PPD) 4 to 12 weeks follow-up · Dental clinic, periodontitis treatment | MD -0.986 [-2.333, 0.362] GRADE not reported Studies not reported |
| Ozonated gel or oil as monotherapy | CHX monotherapy | Clinical attachment level (CAL) 4 to 12 weeks follow-up · Dental clinic, periodontitis treatment | MD -1.282 [-1.636, -0.928] GRADE not reported Studies not reported |
| Ozonated gel or oil as monotherapy | CHX monotherapy | Plaque index (PI) 4 to 12 weeks follow-up · Dental clinic, periodontitis treatment | SMD -0.213 [-0.593, 0.166] GRADE not reported Studies not reported |
| Ozonated gel or oil as adjunct to subgingival instrumentation | None (pre-post change within ozone groups, no control) | Plaque index (PI) 4 to 12 weeks follow-up · Dental clinic, periodontitis treatment | SMD -3.192 [-4.363, -2.021] GRADE not reported Studies not reported |
| Ozonated gel or oil as adjunct to subgingival instrumentation | None (pre-post change within ozone groups, no control) | Probing pocket depth (PPD) 12 weeks follow-up · Dental clinic, periodontitis treatment · Subgroup: 12 weeks follow-up (no-control analysis; intervention form not specified in Table 3) | MD -1.882 [-2.402, -1.362] GRADE not reported Studies not reported |
| Ozonated gel or oil as adjunct to subgingival instrumentation | None (pre-post change within ozone groups, no control) | Probing pocket depth (PPD) 4 to 12 weeks follow-up · Dental clinic, periodontitis treatment | MD -2.130 [-2.882, -1.377] GRADE not reported Studies not reported |
| Ozonated gel or oil as adjunct to subgingival instrumentation (pre-post change) | Baseline before treatment (no control group) | Bleeding on probing (BoP) Short-term follow-up, 4 to 12 weeks (most studies 12 weeks) · Fixed-effect | -1.881 [-2.268, -1.494] GRADE not reported Studies not reported |
| Ozonated gel or oil as adjunct to subgingival instrumentation | None (pre-post change within ozone groups, no control) | Clinical attachment level (CAL) 12 weeks follow-up · Dental clinic, periodontitis treatment · Subgroup: 12 weeks follow-up (no-control analysis; intervention form not specified in Table 3) | MD -2.110 [-2.739, -1.481] GRADE not reported Studies not reported |
| Ozonated gel or oil as adjunct to subgingival instrumentation | None (pre-post change within ozone groups, no control) | Clinical attachment level (CAL) 4 to 12 weeks follow-up · Dental clinic, periodontitis treatment | MD -2.469 [-3.850, -1.088] GRADE not reported Studies not reported |
| Ozonated gel or oil as adjunct to subgingival instrumentation | None (pre-post change within ozone groups, no control) | Gingival index (GI) 4 to 12 weeks follow-up · Dental clinic, periodontitis treatment | SMD -3.282 [-4.688, -1.876] GRADE not reported Studies not reported |
| Ozonated gel or oil as monotherapy | None (pre-post change within ozone groups, no control) | Plaque index (PI) 4 to 12 weeks follow-up · Dental clinic, periodontitis treatment | SMD -1.591 [-2.564, -0.618] GRADE not reported Studies not reported |
| Ozonated gel or oil as monotherapy | None (pre-post change within ozone groups, no control) | Probing pocket depth (PPD) 4 to 12 weeks follow-up · Dental clinic, periodontitis treatment | MD -3.119 [-6.343, 0.105] GRADE not reported Studies not reported |
| Ozonated gel or oil as monotherapy | None (pre-post change within ozone groups, no control) | Clinical attachment level (CAL) 4 to 12 weeks follow-up · Dental clinic, periodontitis treatment | MD -3.145 [-6.535, 0.245] GRADE not reported Studies not reported |
| Ozonated gel or oil as monotherapy | None (pre-post change within ozone groups, no control) | Gingival index (GI) 4 to 12 weeks follow-up · Dental clinic, periodontitis treatment | SMD -2.281 [-3.181, -1.380] GRADE not reported Studies not reported |
| Ozonated gel or oil | Not specified (meta-regression across studies) | Plaque index (PI) 4 to 12 weeks follow-up · Dental clinic, periodontitis treatment · Meta-regression on follow-up duration (3 weeks to 3 months studies) | Meta-regression coefficient (follow-up duration) 0.0684 GRADE not reported Studies not reported |
| Ozonated gel or oil | Not specified (meta-regression across studies) | Clinical attachment level (CAL) 4 to 12 weeks follow-up · Dental clinic, periodontitis treatment · Meta-regression on follow-up duration (3 weeks to 3 months studies) | Meta-regression coefficient (follow-up duration) -0.026 GRADE not reported Studies not reported |
| Ozonated gel or oil | Not specified (meta-regression across studies) | Probing pocket depth (PPD) 4 to 12 weeks follow-up · Dental clinic, periodontitis treatment · Meta-regression on follow-up duration (3 weeks to 3 months studies) | Meta-regression coefficient (follow-up duration) 0.0275 GRADE not reported Studies not reported |
Included primary studies 21
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 |
| 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 |
| Mukherjee 2024 Efficacy of Olive Oil, Ozonated Olive Oil, and Chlorhexidine Gel as an Adjunct to Scaling and Root Planing in Chronic Periodontitis: A… PMID:39926739 | 2024 | 1 other review | not stated | not extracted yet |
| Patel 2025 Evaluating Ozonated Olive Oil and Chlorhexidine Gel as a Therapeutic Intervention for Periodontitis Stage II Grade A. PMID:40585734 | 2025 | 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 |
| Barahim 2024 Clinical and radiographic evaluation of non-surgical therapy with and without ozone gel application in controlled type 2 diabetic patients… PMID:39587593 | 2024 | this review only | not stated | not extracted yet |
| Carmo 2025 Effect of ozone oil and non-surgical periodontal treatment in patients with type 2 diabetes. In-vivo and in-vitro studies with fibroblasts… PMID:39841769 | 2025 | this review only | not stated | not extracted yet |
| Desingu 2024 Comparative Evaluation of the Efficacy of Subgingival Irrigation of Ozonated Olive Oil with Gingelly Oil in Chronic Periodontitis Patients DOI:10.5005/jp-journals-10015-2458 | 2024 | this review only | not stated | not extracted yet |
| Lauritano 2023 matched by author and year (probable) | NR | this review only | not stated | not extracted yet |
| Lendhey 2020 matched by author and year (probable) | NR | this review only | not stated | not extracted yet |
| Saeed 2017 matched by author and year (probable) | NR | this review only | not stated | not extracted yet |
| Scribante 2024 Ozonized gels vs chlorhexidine in non-surgical periodontal treatment: A randomized clinical trial. PMID:38047757 | 2024 | this review only | not stated | not extracted yet |
| Sheikh 2020 (Rawdy) matched by author and year (probable) | NR | this review only | not stated | not extracted yet |
| Sheikh 2020 (Table 1 label; Rawdy 2020 in reference list) matched by author and year (probable) | NR | this review only | not stated | not extracted yet |
| Shoukheba 2014 matched by author and year (probable) | NR | this review only | not stated | not extracted yet |
| Singh 2024 matched by author and year (probable) | NR | this review only | not stated | not extracted yet |
| Singh 2024 (Naganandini 2024 in reference list) Effect of ozonated oil versus chlorhexidine gel among Indian patients with chronic periodontitis. PMID:39411757 | 2024 | this review only | not stated | not extracted yet |
| Vignesh 2022 Adolescent Same-Sex Attraction and Academic Outcomes: The Role of School Attachment and Engagement. PMID:20221417 | 2007 | this review only | not stated | 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 | Patients with periodontitis | Patients with chronic, aggressive or stage II-III periodontitis, including diabetic and smoker patients (n=19 studies) |
| Intervention | Oil or gel formulations of ozonated compounds as monotherapy or adjunct to subgingival instrumentation | Ozonated olive, sunflower or other oil or gel as adjunct to subgingival instrumentation or monotherapy (n=19) |
| Comparison | No intervention, placebo, or CHX | Subgingival instrumentation alone or with placebo; CHX gel or monotherapy |
| Outcomes | PPD, PI, GI (primary); CAL, clinical attachment loss, BoP, SBI (secondary) | PPD, PI, GI, CAL, BoP, SBI |
| Study designs | Randomized controlled or quasi-experimental trials published in English | RCTs (17) and non-RCTs (2) in qualitative synthesis; 18 RCTs in quantitative synthesis |
| Timing | Not specified | Follow-up 4 to 12 weeks (most 12 weeks) |
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 | Partial Yes | yes |
| 3Choice of study designs explained | No | No | yes |
| 4Comprehensive literature searchcritical | Partial Yes | No | no |
| 5Study selection in duplicate | Yes | Yes | yes |
| 6Data extraction in duplicate | Yes | Yes | 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: Partial Yes | NRSI: Partial Yes · RCT: 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 |