Ozonized Hydrogel and Chlorhexidine Gel for Peri- Implant Mucositis: A 24- Month Randomized Controlled Trial

Background: inflammation around dental implants

Peri-implant mucositis is a reversible inflammation of the soft tissue around a dental implant, marked by bleeding on gentle probing but without bone loss. Left unmanaged it can progress to peri-implantitis, where bone is lost and the implant itself is at risk.

The usual adjunct to cleaning is chlorhexidine gel. It works, but long-term use carries well-known drawbacks including tooth staining, altered taste and mucosal irritation. This trial asked whether an ozonated oil hydrogel could do the same job.

Study design: 30 patients, 360 sites, split-mouth over 24 months

Thirty patients with a total of 360 peri-implant mucositis sites took part. The trial used a split-mouth design, meaning each patient received both treatments in different, randomly assigned quadrants of their own mouth - so each person acted as their own control.

One treatment was a 15% ozonated sunflower oil hydrogel; the other a 1% chlorhexidine gel. Clinical measurements were taken at baseline and at nine follow-up points across 24 months: probing pocket depth, plaque index, bleeding on probing, bleeding score, suppuration index and marginal mucosal condition.

Findings: better bleeding and suppuration outcomes than chlorhexidine

Both treatments improved the clinical measures. The ozonated hydrogel produced superior anti-inflammatory effects compared with chlorhexidine, with the clearest differences in reducing bleeding and suppuration.

Marginal bone levels remained stable in both groups across the two years.

What the authors concluded

The authors conclude that the ozonated sunflower hydrogel outperformed chlorhexidine on the inflammatory measures while preserving bone stability, and that its safety, efficacy and acceptability to patients support its use as an adjunct in the ongoing maintenance of peri-implant mucositis.

Notably, this is a maintenance and hygiene role alongside professional dental care - not a replacement for it.

Limitations of this study

The trial involved 30 patients at a single centre. The split-mouth design controls well for differences between patients, but it cannot rule out some carry-over of effect between quadrants of the same mouth. The paper was published online ahead of print in October 2025.

If you are managing peri-implant inflammation, this is a conversation to have with your dentist or dental hygienist rather than something to self-treat.