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Dental Ozone Protocol: Gum Disease, Peri-Implantitis and Implant Stability
Settings published human studies used for gas in gum pockets, around inflamed implants and at implant placement. As an add-on to scaling, about half the trials found no added benefit.
Quick answer: In gum pockets, published human studies used gas by probe tip for 20–30 s per pocket over 3–4 sessions, or 2 mL at 30 µg/mL by needle. Peri-implantitis used 6 points × 30 s. As an add-on to scaling, about half the trials found no added benefit.
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 for gum disease and implants?
- Periodontitis, as an add-on to scaling and root planing: about half the randomized trials show no added benefit. Of the 8 trials on file, 3 favored ozone and 5 found no difference.
- Peri-implantitis (gum inflammation around an implant) has two small RCTs with opposite leanings, and implant placement has three small studies that lean toward ozone for early implant stability.
- All periodontitis studies used ozone after scaling, not instead of it.
Mixed: gas as an add-on to scaling shows no added benefit in about half the randomized trials.
What dose and settings are used for ozone for gum disease and implants?
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 | |
|---|---|---|---|
| Periodontitis, add-on to scaling and root planing | Probe-tip device | 2,100 ppm in 80% O2, or power level 8–10 | Tip in the pocket for 20–30 s per pocket (some trials 60 s), after scaling. 3–4 sessions, every 3 days to weekly. In one trial a maintenance session at power 4–5 was added later. |
| Periodontal pocket gas by needle | Medical generator | 2 mL at 30 µg/mL per pocket (60 µg) | 4 sessions |
| Peri-implantitis (protocol A) | Probe-tip device | 2,100 ppm | 6 points × 30 s (3 min) per implant on days 0, 2 and 4, plus once during surgery |
| Peri-implantitis (protocol B) | Probe-tip device | 2,100 ppm | 4 sites × 15 s (60 s) per implant |
| Implant stability, after placement | Probe-tip device | Power level 15 | 60 s per site, single application |
| Implant stability, drill site | 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) |
| Implant stability, repeated sessions | Probe-tip device | 80% (as printed) | 3–6 min, 6 sessions |
Madrid's dental addendum: Madrid says there is no consensus on concentration, dose and timing for ozone gas injections in dentistry (Addendum A, section 1) and gives no gas dose for gum disease itself. Its general gas ranges (Table 5) are 5–20 µg/mL (low severity), 20–40 (medium) and 40–80 (high) for 30 seconds up to 2 minutes, described as a guide and not a strict protocol. Device settings in the table (ppm, power level, seconds) are not directly comparable to Madrid's µg/mL values.
Unit key: 1 g/m³ equals 1 µg/mL. 2,100 ppm is about 4.2 µg/mL and 2,350 ppm about 4.7 µg/mL. Power levels and percent settings have no µg/mL value.
What are the best tips when using ozone for gum disease and implants?
- Set expectations: for periodontitis, the gas is an extra after scaling and root planing. About half the trials found it added nothing measurable.
- The one trial in people with diabetes (100 people, HbA1c outcome) found no difference.
- 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 for gum disease and implants, and who should avoid it?
- In the peri-implantitis comparison with the 60-second protocol, the trend favored the control treatment, not ozone (Eraydin-Tufek 2026).
- 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.
- Gas given by needle can enter a blood vessel and cause a gas embolism. Madrid advises injecting in small steps of under 1 mL, slowly, with the patient seated and watched. Stop at once if the patient develops chest pain, breathlessness, pallor or confusion, and call emergency services. The 2 mL per pocket in the trial above is more than that advice.
- 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
- Probe-tip dental ozone device with a periodontal tip (or a medical generator, syringe and fine needle for pocket gas)
- Suction or an ozone destruct unit at the mouth
- Scaling and root-planing instruments
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).
- Periodontitis, favors ozone: RCT of 90 (J Clin Med 2024), RCT of 90 (80 analysed) in adults with no systemic disease (Int J Environ Res Public Health 2022), RCT of 36 (Pardo 2026).
- Periodontitis, no difference: RCT of 100 in diabetics (Int J Environ Res Public Health 2020), RCT of 37 (J Appl Oral Sci 2019), 18 patients (J Dent Sci 2019), RCT of 48 with intrabony defects (bone loss inside the gum pocket) (Clin Oral Investig 2024), 17 patients (BMC Oral Health 2026).
- Gas into pockets by needle, 2 mL at 30 µg/mL: RCT of 32, our summary marks it not tested (J Clin Med 2022).
- Peri-implantitis protocol A: RCT of 41, favors ozone (J Periodontal Implant Sci 2018). Protocol B: RCT of 26, trend favors control (Eraydin-Tufek 2026).
- Implant stability: power 15, 60 s, RCT of 40, favors ozone (Çakır Erdil 2026). Drill site 30 s, RCT of 84, favors ozone (Cureus 2025). 3–6 min × 6 sessions, non-randomized study of 25, partly favors ozone (Niger J Clin Pract 2018).
Evidence is mixed for periodontitis and thin for peri-implantitis and implant stability: small trials, different devices, no shared setting.
Learn more
Background, benefits and research on dental ozone: Ozone in dentistry, full article.
Related protocols: Dental Ozone Protocol: Oral Surgery and Healing, Dental Ozone Protocol: Root Canal Disinfection and Pulp Capping, Dental Ozone Protocol: Mouth Sores, Lichen Planus and Ulcers.
Other dental protocols
For licensed practitioners. Educational reference only, not medical advice. Follow your scope of practice and local regulations.