Is Ozone Therapy Effective in Preventing and Treating Alveolar Osteitis? A Systematic Review

BACKGROUND: Alveolar Osteitis (AO) is a frequent postoperative complication following tooth extraction that negatively affects patients' quality of life and requires repeated follow-up visits. To prevent this condition and reduce postoperative discomfort, several clinical strategies and therapeutic compounds have been proposed, but its incidence remains clinically relevant. PURPOSE: This systematic review aims to evaluate the clinical effectiveness of ozone therapy in the prevention and treatment of AO in adult patients undergoing tooth extraction or diagnosed with AO. The review focused on different ozone formulations (gaseous ozone, ozonated water, and ozonated oils/gels) and assessed outcomes including AO frequency, postoperative pain, analgesic consumption, and healing. STUDY SELECTION: A comprehensive search on scientific databases was conducted up to April 2025. Randomized controlled trials (CTs), CTs, and prospective clinical studies evaluating ozone as a preventive or therapeutic intervention for AO in adults were included. Animal studies, in vitro studies, studies without a control group, and those using ozone only in combination with other adjunctive therapies were excluded. Two independent reviewers screened titles, abstracts, and full texts, with disagreements resolved by consensus or arbitration. Of 55 records initially identified, 8 studies (14.5%) met the inclusion criteria. RESULTS: Seven studies evaluated ozone as a preventive adjunct following surgical tooth extraction. Gaseous ozone and sunflower oil-based ozone gel were generally associated with a lower frequency of AO and improved postoperative pain control, although the overall certainty of evidence was limited by methodological concerns. Studies assessing ozonated water reported conflicting and inconsistent results. Only one trial investigated the therapeutic use of ozone in established AO, finding promising results when combined with concentrated growth factors. CONCLUSIONS AND RELEVANCE: Ozone therapy may represent a promising adjunctive approach for reducing the frequency of AO and improving postoperative outcomes after third molar surgery. However, the currently available evidence remains limited and heterogeneous, and further well-designed randomized CTs are needed to clarify its clinical effectiveness and optimal delivery protocols.