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Dental Ozone Protocol: Root Canal Disinfection and Pulp Capping
Settings published reports used for gas in root canals and on the exposed pulp. The evidence is case reports and one small controlled study.
Quick answer: Reports used a timed burst of 6–24 s in the canal, or a generator at 60 µg/mL and 100 mL, over 3 appointments. Pulp capping used 18–24 s. The evidence is case reports and one small controlled study.
Warning
Requires training in ozone dentistry
Dental ozone should only be performed by a dental professional trained in ozone dentistry. Gas applied in the mouth carries a higher risk of breathing ozone, which is why devices seal over the tooth and use suction (vacuum) to pull the gas away. Never let the patient inhale ozone gas.
This sheet summarizes what published human studies used. It is not a self-treatment guide and not medical advice. Settings are printed as each study reported them, by device family, and cannot be compared across devices.
What are the basics of ozone in root canals and pulp?
- Root canal disinfection and pulp capping rest on case reports and a small controlled study. There is no randomized trial of dental gas in the root canal on file.
- In the pulp-capping reports, gas was only one step: it was used to disinfect the dentin wound, and a platelet-rich fibrin membrane or capping material was then placed. The reports cannot separate the gas from the rest of the treatment.
Case-level evidence only.
What dose and settings are used for ozone in root canals and pulp?
One row per use. Settings are exactly as the studies printed them; "not stated" means the paper did not give it.
| Device family | Setting as printed | Time and schedule | |
|---|---|---|---|
| Root canal disinfection (protocol A) | Timed-burst handpiece | Preset dose, set by seconds (dose not stated) | Gas in the canal for 6, 12, 18 and 24 s in turn after instrumentation and irrigation with sodium hypochlorite and EDTA (the study sampled bacteria after each exposure); suction on. One case report: 24 s at the first visit and again after 7 days. |
| Root canal disinfection (protocol B) | Medical generator | Gas 60 µg/mL, 100 mL into the canal; ozonated water 15 µg/mL | 3 appointments |
| Pulp capping, reversible pulpitis | Timed-burst handpiece | Preset dose (18 s is about 165 µg) | 18–24 s on the exposed pulp, then the capping material |
Madrid's dental addendum: For root canals, Madrid (section 5.1) fills each canal with ozone gas at 40–80 µg/mL for 1–2 minutes, using a handpiece or a manual 100 mL syringe, while the excess is suctioned out. It also lists a periapical injection of 1–2 mL at 5–10 µg/mL, repeated on later visits. Device settings in the table (ppm, power level, seconds) are not directly comparable to Madrid's µg/mL values.
What are the best tips when using ozone in root canals and pulp?
- Use suction while gas is in the canal.
- Hold the syringe tip still in the canal and suction the excess gas out as it is delivered (Madrid 5.1). Madrid uses 40–80 µg/mL for 1–2 minutes in each canal.
- Settings are device-specific (ppm, power level, seconds). Use your own device's program and do not convert one family's setting into another's.
- Most single-tooth uses were one application. Where the studies gave a schedule, it is in the table.
What are the precautions for ozone in root canals and pulp, and who should avoid it?
- Device families used in this sheet (generic descriptions). Sealed-cup (vacuum) device: a silicone cup seals over the tooth and holds a vacuum. Probe-tip device: a handpiece with a tip, usually a fixed concentration or a power level. High-frequency tip generator: ozone is made at the tip and set by power percent. Timed-burst handpiece: a preset dose set by seconds. Medical generator: a standard medical ozone generator giving a dose in µg/mL, with a syringe or custom sealed tray.
- Use high-volume suction or an ozone destruct unit at the mouth, and ventilate the room.
- Screen the patient first. Review pregnancy, heart or bleeding conditions and blood thinners with the patient's physician before gas is used.
- The Madrid Declaration on Ozone Therapy, 4th edition (ISCO3, 2025) dentistry addendum (Addendum A, section 2.1) sets the safety rules for gas in the mouth: stop at the first smell of ozone and check for leaks; use the dental unit's high-volume suction even when the handpiece has its own suction line; seal custom trays at every edge and test the seal before use; and keep 1 g of vitamin C and medical oxygen with a mask (3 L/min) in the office in case the patient breathes in ozone. For cup or tray gas on tooth surfaces (section 4.1), Madrid lists as contraindications: a tooth or mouth shape that stops a full seal, no high-volume suction, and a tooth with an apical lesion (endodontic treatment or extraction fits better). The full contraindication list in section 2.1 of the main text is written for ozone given through the body. How MediSkill handles contraindications is explained in the contraindications article.
- Use medical oxygen to make the gas. Madrid says generators that run on room air also make harmful nitrogen compounds, and industrial oxygen must not be used. Many of the dental studies here used such devices, so their settings may not match a medical-oxygen generator. Madrid's dentistry addendum allows an oxygen concentrator of 95% or higher purity for topical dental use and calls for medical-grade oxygen (99.9%) for any injection. MediSkill's rule is medical oxygen.
- Check your licensing board and that your device is cleared for dental use where you practice.
More detail
Equipment
- Timed-burst handpiece with a canal tip, or a medical generator with syringe and canal-compatible tubing
- Suction or an ozone destruct unit
- Standard endodontic instruments and isolation
What the studies used
Study doses are listed as printed in each paper. They are not Madrid dosing; see the Madrid line under the dosing table.
- Canal disinfection, protocol A: non-randomized controlled study of 40, our summary marks it not tested (Ajeti 2018); a case report of an endo-perio lesion (a lesion involving both the root canal and the gum) (Clin Cosmet Investig Dent 2020).
- Canal disinfection, protocol B: a case report with an 11-year follow-up (Nogales 2019).
- Pulp capping, reversible pulpitis: two case reports of 2 patients each, with a dentin bridge and preserved pulp vitality at follow-up, both alongside platelet-rich fibrin (Kirilova 2023; Kirilova 2026).
Evidence is thin: case reports and one small non-randomized study, with no comparison group in the pulp-capping reports.
Learn more
Background, benefits and research on dental ozone: Ozone in dentistry, full article.
Related protocols: Dental Ozone Protocol: Mouth Sores, Lichen Planus and Ulcers, Dental Ozone Protocol: Medication-Related Osteonecrosis of the Jaw (MRONJ), Dental Ozone Protocol: Tooth Decay and Sensitivity.
Other dental protocols
For licensed practitioners. Educational reference only, not medical advice. Follow your scope of practice and local regulations.