Intraoperative gaseous ozone and early implant stability: a randomized split‑mouth trial and what it means for your chair

A single randomized split‑mouth trial found a small, statistically significant rise in ISQ at three months after a 60‑second ozone application to the osteotomy, but the clinical importance is limited — useful as a possible adjunct if you already use ozone, not a reason to buy one yet.

What the study did. A prospective, randomized split‑mouth trial of 40 patients (106 implants) tested whether applying gaseous ozone into the implant osteotomy for 60 seconds immediately before placement improves early implant stability measured by resonance frequency analysis (ISQ). Patients and outcome assessors were blinded; the same implant system and surgical protocol were used on both sides. No adverse events were reported. ([mdpi.com](

What the numbers show. Baseline ISQ and insertion torque were similar between ozone and control sides. At three months the ozone side had a higher mean ISQ (adjusted difference about +1.9 ISQ units) and the change from baseline (ΔISQ) favoured ozone by ~2.4 ISQ units (Cohen’s d ≈ 0.42). Both sides gained stability over time. However, the patient‑level paired analysis of ΔISQ did not reach statistical significance (p = 0.089), and the authors stress that the effect size was modest and sensitive to analytical choices. Post‑operative pain was unchanged. ([mdpi.com](

How to read those ISQ numbers. ISQ is a useful longitudinal monitor but not a binary ‘pass/fail’ test. Systematic reviews show moderate correlation between insertion torque and ISQ and that ISQ values have measurement variability; differences of a few ISQ points are often within measurement noise and may not change clinical decisions such as timing of loading. In other words, a true mean gain of ~2 ISQ units is small and unlikely by itself to let you move from delayed to immediate loading. The trial authors and recent reviews both recommend caution before treating such small ISQ shifts as clinically decisive. ([pmc.ncbi.nlm.nih.gov](

Biology and plausible mechanism. Low‑dose ozone has broad antimicrobial and mild oxidative signalling effects that in preclinical work can upregulate markers of bone formation and angiogenesis; applying ozone to a fresh osteotomy could modestly influence local biology in the early healing window. The trial’s finding that baseline mechanical measures (torque, baseline ISQ) were unchanged, but later ISQ rose slightly, fits the idea of a biological rather than purely mechanical benefit. ([mdpi.com](

Practical takeaways for a busy clinic. If you already own an approved dental ozone unit and are trained in its safe intraoral use, a 60‑second, probe‑to‑osteotomy application as used in the study is a reasonable, low‑risk adjunct to consider for cases where you want every small advantage to early osseointegration (for example, medically compromised bone or lower expected secondary stability). If you do try it, follow the study parameters: 60 s gaseous ozone delivered with the manufacturer‑recommended probe position and suction, and keep standard asepsis and antibiotic/analgesic protocols unchanged. If you do not already use ozone, this single moderate‑sized trial does not provide enough benefit to justify purchasing equipment solely for this purpose. ([mdpi.com](

Limitations and what to watch for. The study is single‑centre, modestly sized, and the ISQ advantage is small and sensitive to analysis. ISQ is a surrogate; the trial reports no adverse events but did not provide long‑term survival or prosthetic outcomes. We need larger multicentre RCTs with implant survival, marginal bone loss and patient‑centred endpoints before recommending routine adoption. Meanwhile, prioritize fundamentals — implant position, primary stability, atraumatic technique, and good soft‑tissue management — over adjunctive tricks. ([mdpi.com](