Ozonated Water Irrigation in Periodontitis: A Randomised Trial of 50 Patients (2025)

Background

Periodontitis is a chronic inflammatory disease in which a bacterial film below the gumline gradually destroys the tissues that hold the teeth in place. The standard first treatment is a professional deep clean - scaling and root debridement - but, as the authors note, instruments alone cannot fully clear bacteria from deep pockets and the hard-to-reach areas where roots divide.

Ozone has been studied as an add-on because it is antimicrobial, disrupting bacterial cell membranes, and because it appears to calm the inflammatory response. The team, from the Department of Periodontology and Implantology at the Government Dental College and Hospital in Jamnagar, India, set out to test whether flushing the gum pockets with ozonated water after a deep clean would add anything to the clean on its own.

Study design

This was a randomised controlled trial, registered with the Clinical Trials Registry of India (CTRI/2024/11/076547) and run between March and October 2024. Fifty adults aged 25 to 60 with stage III periodontitis - pockets of at least 4 mm that bled on probing - were allocated to two groups of 25. People who smoked, were pregnant, had systemic disease, had taken antibiotics recently or had periodontal treatment in the previous six months were excluded.

Everyone received the same deep clean. The test group then had every tooth irrigated below the gumline with freshly generated ozonated water at around 2 parts per million, delivered through a blunt-tipped syringe; the control group had the identical procedure with saline. Patients were not told which liquid they received. Plaque, bleeding, pocket depth and clinical attachment level were measured at the start and after four weeks.

This was a single clinic procedure carried out by dental staff. It is a description of what was studied, not a set of instructions.

Findings

Plaque. The plaque score fell from 83.8 per cent to 55.9 per cent with ozonated water, against 78.1 to 60.2 per cent with saline.

Bleeding. The bleeding score fell from 83.7 per cent to 55.9 per cent with ozonated water, against 74.7 to 57.7 per cent with saline.

Pocket depth. Pockets shrank from an average of 5.16 mm to 4.10 mm with ozonated water - a reduction of just over 1 mm - against 5.03 to 4.44 mm with saline.

Gum attachment. Clinical attachment level improved by 0.93 mm with ozonated water against 0.37 mm with saline.

Both groups improved on every measure, and the difference between the groups favoured ozonated water on all four (p < 0.001). No adverse effects were reported.

What the authors concluded

The authors conclude that "ozone irrigation alongside nonsurgical periodontal therapy offers adjunctive benefits by reducing clinical parameters". In their discussion they describe ozone as a novel adjunctive modality to mechanical debridement, and call for well-controlled trials with better methodologies to understand its efficacy.

Limitations of this study

The authors point to the lack of microbiological and biochemical measurements, the small size of their subgroup analysis, and ozone's unstable nature and lack of lasting action on tooth surfaces, which they say limits its effect in the deepest pockets. The follow-up was four weeks.

For readers: this tested a single professional irrigation straight after a deep clean, not daily use at home, so it does not show what regular home irrigation would do. It is also a single-centre trial of 50 people. The research received no specific funding and the authors declare no competing interests.

Gum disease should be diagnosed and managed with your dentist or hygienist.

Related reading

Effects of Ozone Therapy as an Adjuvant in Periodontitis: A Meta-Analysis of 13 Trials (2025)

Ozonated Water and Chlorhexidine as an Oral Rinse: A Randomised Clinical Study

Efficacy of Ozone Therapy in Dentistry: A Systematic Review of 11 Trials (2025)

Rohith GN, Patel N, Jha R, Vachhani R, Verlianey N, Sant A. Comparative evaluation of ozonized water versus normal saline irrigation with mechanical debridement in chronic periodontitis patients - a clinical study. Journal of Oral Biology and Craniofacial Research. 2025;15(3):594-599. doi:10.1016/j.jobcr.2025.03.014