Ozone Gel in Chronic Periodontal Disease

Background

Chronic periodontitis is a long-term inflammatory disease of the gums and the tissues that support the teeth, and it is one of the leading causes of tooth loss in adults. The standard non-surgical treatment is scaling and root planing (SRP), a deep clean that removes plaque and hardened tartar from below the gumline. SRP is often paired with an antiseptic gel containing chlorhexidine to help control bacteria while the gums heal. Chlorhexidine is effective, but it has recognised drawbacks: it can stain teeth, alter taste, and raises concerns about bacterial resistance with prolonged use. A team of Italian researchers set out to test whether an ozonised gel could offer similar benefits without these downsides.

Study design

This was a randomised, split-mouth clinical trial involving 10 adults (4 men, 6 women, average age 50) diagnosed with stage III, grade B periodontitis - a moderately advanced form of the disease affecting most of the mouth. People with systemic diseases, other oral conditions, smokers, and anyone who had recently used chlorhexidine or other relevant medication were excluded. In a split-mouth design, different quadrants of the same patient's mouth are randomly assigned to different treatments, allowing each person to act as their own control. Here, one side received SRP plus the ozonised gel GeliO3, while the other received SRP plus chlorhexidine gel. Researchers measured probing pocket depth, clinical attachment level, gingival index, plaque index, and bleeding on probing at the start of the study, at one month, and at three months.

Findings

Both treatments led to significant improvements across all measured indices over the three-month period. However, when the two sides of the mouth were compared directly, there was no significant difference between the ozone gel and chlorhexidine gel for most measures. Chlorhexidine did show a significantly greater reduction in clinical attachment level and gingival index at the three-month mark. No adverse effects were reported with either treatment.

What the authors concluded

The authors concluded that, alongside scaling and root planing, the ozonised gel GeliO3 can be regarded as a valid substitute for chlorhexidine - particularly given chlorhexidine's known shortcomings around staining, taste disturbance, and resistance concerns with long-term use.

Limitations of this study

This trial involved only 10 patients, which is a very small sample from which to draw firm conclusions. The split-mouth design, while a useful way to control for individual variation, cannot fully rule out some crossover effect between treated quadrants in the same mouth. Follow-up was limited to three months, so longer-term outcomes are unknown, and the trial was conducted at a single centre. Larger, longer-running trials would be needed to confirm whether ozone gel performs as well as chlorhexidine over time.