Knowledge Center › Protocols › Oral surgery and healing
Practitioner protocol · Dentistry
Dental Ozone Protocol: Oral Surgery and Healing
Settings published human studies used for gas after tooth extraction, at the implant drill site, on gum graft wounds and for orthodontic pain.
Quick answer: Published human studies used gas for 12 s once for dry socket and 30 s once at the implant drill site. Gum graft wounds got 30 s on days 0, 1 and 3, and orthodontic pain got 23 points × 5 s.
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 after oral surgery?
- Studies are small and mostly lean toward benefit. Dry socket prevention after third-molar removal used one 12-second burst into the socket right after extraction; both trials trended in favor of ozone but were underpowered.
- For gum graft healing, gas was applied to the donor and the recipient sites right after surgery and on days 1 and 3. Early healing in week 1 was faster.
- For orthodontic pain, a probe tip was applied to 23 points for 5 seconds each, once after archwire placement.
- For the implant drill site and implant stability, see the gums and implants sheet.
Small trials, mostly leaning toward benefit.
What dose and settings are used for ozone after oral surgery?
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 | |
|---|---|---|---|
| Dry socket prevention after third-molar extraction | Timed-burst handpiece | Preset dose, set by seconds (dose not stated) | 12 s into the socket, once, right after extraction |
| Implant drill site (osteotomy) | Not stated | Gas concentration not stated | Gas through a bent needle for 30 s into the drill site, together with ozonated-saline irrigation (25 µg/mL) and an ozone injection beside the site (volume not stated) |
| Gum graft wound healing | High-frequency tip generator | 75% power (printed as 75 µg/mL) for the first two applications; 30% power (30 µg/mL) for the third | 30 s at the donor site and 30 s at the recipient site each time: right after surgery, on day 1 (75%) and on day 3 (30%) |
| Orthodontic pain | Probe-tip device | Power level not stated | 23 points × 5 s (about 2 min), once after archwire placement |
Madrid's dental addendum: For extractions, Madrid (section 7.3) injects 1 mL of gas at 10 µg/mL at points around the extraction site in the gum tissue, and 1–2 mL at 5–10 µg/mL at 2–3 buccal and lingual gum points. Madrid advises injecting gas in small steps of under 1 mL to avoid a gas embolism (section 7.1). Around orthodontic brackets it uses 20–30 µg/mL for 30–60 seconds (section 6). Madrid does not give a dry-socket gas dose. 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 after oral surgery?
- For dry socket, the gas goes into the socket straight after extraction; both trials used a single 12-second application.
- Prevention of jaw osteonecrosis after extraction is on the MRONJ sheet; in at-risk patients, the one randomized trial measured wound healing: no difference at 6 weeks, better scores at 14 days.
- 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 after oral surgery, 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.
- Implant placement: Madrid (Addendum A, section 7.4) says not to inject ozone into the surgical site at implant placement and not to put ozonated oil on the implant, so the first reaction happens only between implant and bone. The drill-site study above did the opposite. Talk it over with your team before using it.
- Check your licensing board and that your device is cleared for dental use where you practice.
More detail
Equipment
- Dental ozone device matching the family in the table (timed-burst handpiece, tip generator or probe tip)
- Suction or an ozone destruct unit at the mouth
- Surgical field isolation and sterile technique as for any oral surgery
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. "RCT" means randomized controlled trial (people were assigned to groups by chance).
- Dry socket prevention, 12 s once: RCT of 30 (Ahmedi 2016) and a controlled study of 30 (Ahmedi 2023). Both trend in favor of ozone and are underpowered.
- Implant drill site, 30 s: RCT of 84, favors ozone for pain and soft-tissue healing (Cureus 2025).
- Gum graft healing: RCT of 30, direction not reported, faster early healing in week 1 (J Periodontol 2016).
- Orthodontic pain: RCT of 76, trend favors ozone (Lasers Med Sci 2020).
Evidence is thin: each use rests on one or two small trials, several underpowered, and the dose is a single device setting.
Learn more
Background, benefits and research on dental ozone: Ozone in dentistry, full article.
Related protocols: Dental Ozone Protocol: Root Canal Disinfection and Pulp Capping, Dental Ozone Protocol: Mouth Sores, Lichen Planus and Ulcers, Dental Ozone Protocol: Medication-Related Osteonecrosis of the Jaw (MRONJ).
Other dental protocols
For licensed practitioners. Educational reference only, not medical advice. Follow your scope of practice and local regulations.