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Review Article | OPEN ACCESS

A systematic review on the role of ozone therapy in periodontitis

Dwi Wahyu Indrawati1, 2 , Ernie Maduratna Setiawatie3, Retno Pudji Rahayu4, Rizky Briliant Syah Manurung5

1Doctoral Program of Dental Health Sciences, Faculty of Dental Medicine, Universitas Airlangga, Surabaya; 2Department of Dentistry, Universitas Muhammadiyah Sidoarjo, Sidoarjo; 3Department of Periodontics, Faculty of Dental Medicine, Universitas Airlangga; 4Department of Oral Pathology and Maxillofacial, Faculty of Dental Medicine, Universitas Airlangga; 5Resident of Oral and Maxillofacial Surgery, Faculty of Dental Medicine, Universitas Airlangga, Surabaya, Indonesia.

For correspondence:-  Dwi Indrawati   Email: indrawatidwi55@gmail.com

Received: 29 August 2025        Accepted: 29 December 2025        Published: 31 January 2026

Citation: Indrawati DW, Setiawatie EM, Rahayu RP, Manurung RB. A systematic review on the role of ozone therapy in periodontitis. Trop J Pharm Res 2026; 25(1):81-89 doi: https://dx.doi.org/10.4314/tjpr.v25i1.11

© 2026 The authors.
This is an Open Access article that uses a funding model which does not charge readers or their institutions for access and distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0) and the Budapest Open Access Initiative (http://www.budapestopenaccessinitiative.org/read), which permit unrestricted use, distribution, and reproduction in any medium, provided the original work is properly credited..

Abstract

Bacterial infection triggers periodontitis, which is a long-standing inflammatory disease of the oral cavity that damages the tissues supporting the teeth. Ozone therapy, known for its antimicrobial, anti-inflammatory, and biostimulatory effects, has been applied as an adjunct in periodontal treatment. This review evaluates its efficacy in lowering inflammatory markers, including matrix metalloproteinase-8 (MMP-8), interleukin-1 beta (IL-1β), and tumor necrosis factor-alpha (TNF-α) and its potential to enhance the repair of periodontal tissues. A thorough search of major bibliographic databases, such as PubMed, Scopus, and Google Scholar, was carried out. Studies investigating alterations in inflammatory biomarkers among patients receiving ozone therapy for periodontitis, which examined both before and after the interventions, were considered for inclusion. Data extraction emphasized both the levels of these biomarkers and clinical measures reflecting periodontal recovery. The review indicates that ozone therapy significantly reduces inflammatory biomarkers, particularly MMP-8, IL-1β, and TNF-α, inhibits periodontal tissue degradation, and promotes healing by modulating both microbial activity and host response. Ozone therapy shows promise as an adjunctive treatment for periodontitis by reducing inflammation and supporting tissue repair. However, additional randomized clinical trials are warranted to confirm its long-term efficacy and the standardization of treatment protocols.

Keywords: Ozone therapy, Periodontitis, Inflammatory biomarkers, Periodontal healing

Impact Factor
Thompson Reuters (ISI): 0.6 (2023)
H-5 index (Google Scholar): 49 (2023)

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