Effect of Ozone Gel on Postoperative Sequelae after Surgical Removal of Impacted Lower Third Molars.


  • Sherwan Faisal Hamadamin Department of Oral and Maxillofacial Surgery, College of Dentistry, Hawler Medical University, Erbil, Iraq.
  • Ahmad Abdulla Haider Department of Oral and Maxillofacial Surgery, College of Dentistry, Hawler Medical University, Erbil, Iraq.




Ozone Gel, Impaction, Third Molar Surgery, Pain, Swelling, Trismus, Dry Socket, Soft Tissue Healing


Background and objectives: the study aims to evaluate the efficacy of ozone gel in reducing pain, swelling, trismus and also to evaluate soft tissue healing and dry socket after surgical removal of impacted lower third molars.

Methods: the current study enrolled 50 patients divided randomly in to two equal groups, Group I (study group) received ozone gel intra-socket and oral placebo postoperatively and Group II (control group) received a systemic antibiotic. Clinical examination includes assessment of maximal mouth opening on the day of surgery, panoramic x-ray was used for evaluation of the location and configuration of impacted lower third molars, surrounding bone, mandibular canal and adjacent tooth. Pain and swelling were assessed by visual analogue scale (VAS) and recorded daily for one week by the patients, dry socket was checked at 3rd day postoperatively, maximal mouth opening also was checked at 3rd and 7th day postoperatively and soft tissue healing was checked at 7th day postoperatively.

Results: Results showed statistical significance difference regarding pain and swelling and there was no statistically significant difference regarding maximal mouth opening (trismus), dry socket and soft tissue healing in Group I (study group).

Conclusion: This study concluded that the use of ozone gel was effective in the reduction of postoperative pain and swelling but it was not effective in reducing trismus, dry socket and soft tissue healing after surgical removal of impacted lower third molars.


Green R, Pynn B ,Brauer H.(2013). Complications during and after surgical removal of Third molars. Oral Heal Gr .;1:1-11 .

Deliverska E, Petkova M. (2016). Complications After Extraction of Impacted Third Molars-Literature Review .J IMAB.;22(3):1202-11 .

Baqain ZH, Karaky AA, Sawair F, Khraisat A, Duaibis R, Rajab LD(2008). Frequency estimates and risk factors for postoperative morbidity after third molar removal: A prospective cohort study. J Oral Maxillofac Surg;66:2276-83.

Markiewicz MR, Brady MF, Ding EL, Dodson TB. (2008). Corticosteroids reduce postoperative morbidity after third molar surgery: a systematic review and meta-analysis. J Oral Maxillofac SurgSep;66(9):1881-94

Alkholy S.S., Mahmoud A. Abdallah1, Abdel Aziz B. Abdullah (2011). Evaluation of Topical Ozone Gel on Postoperative Sequelae Following Impacted Lower Third Molar Surgery. AADJ, Vol. 2, No. 2, October (2019) — PP. 125:133

Bocci V. Biological and clinical effects of ozone Has ozone therapy a future

in medicine? Br J Biomed Sci. 1999;56:270–9.

Elvis AM, Ekta JS (2011). Ozone therapy: a clinical review. J Nat Sci Biol Med. 2011;2:66–70.

Huth KC, Jakob FM, Saugel B, Cappello C, Paschos E, Hollweck R, Hickel R, Brand K (2006). Effect of ozone on oral cells compared with established antimicrobials. Eur J Oral Sci. 2006;114:435–440.

Poveda R, Bagan J, Carbonell E. (2009). Antibiotic used in dental practice .A review . Med Oral Cir. Buccal.;12(3):186-92.

Libonati, A., Di Taranto, V., Mea, A., Montemurro, E., Gallusi, G., Angotti, V., Nardi, R., Paglia, L., Marzo, G., & Campanella, V. (2019). Clinical antibacterial effectiveness Healozone Technology after incomplete caries removal. European journal of paediatric dentistry, 20(1), 73–78

Saini R(2011). Ozone therapy in dentistry: A strategic review J Nat Sci Biol Med .;2(2):151-3.

Samad, A. A., Haider, A. A., & Shihab, O. I. (2016). Comparison between flapless and flap dental implant surgery: A clinical and radiographic study. Zanco Journal of Medical Sciences (Zanco J Med Sci), 20(2), 1267 _ 1271. https://doi.org/10.15218/zjms.2016.0019

Gonshor A (2002). Technique for Producing platelet-rich plasma and platelet concentrate backgroung and process. Int J periodontics Restorative Dent.P:1-22 (6):547-58.

Blum IR. Contemporary views on dry socket (alveolar osteitis): A clinical appraisal of standardization, aetiopathogenesis and management: A critical review. Int J Oral Maxillofac Surg. 2002;31:309–17.

Oliveira S, Melo A, Agnelli R, Maia P, Kalil S, Porta K (2013). Effect of low-level laser therapy on the post-surgical inflammatory process after third molar removal: Study protocol for a double-blind randomized controlled trial. Trials.;14(1):373-9.

Sivalingam VP, Panneerselvam E, Raja KV, Gopi G. Does topical ozone

therapy improve patient comfort after surgical removal of impacted

mandibular third molar? A randomized controlled trial. J Oral Maxillofac

Surg. 2017;75:51.e1–9

Haraji A, Rakhshan V (2015). Chlorhexidine gel and less difficult surgeries might reduce post-operative pain, controlling for dry socket, infection and analgesic consumption: a split-mouth controlled ran domised clinical trial. J Oral Rehabil 2015;42:20

El-Soud NA, El Shenawy H (2010). A randomized double blind clinical study on the efficacy of low level laser therapy in reducing pain af ter simple third molar extraction. Maced J Med Sci 2010;3:30

Bienstock DA, Dodson TB, Perrott DH, Chuang SK (2011). Prognostic factors affecting the duration of disability after third molar remov al. J Oral Maxillofac Surg 2011;69:1272-7.

Khamverdi N, Alishahi HK, Haraji A, Rakhshan V (2013). Effects of intraalveolar placement of 0.2% chlorhexidine bioadhesive gel on dry socket incidence and postsurgical pain: a double-blind split-mouth randomized controlled clinical trial. J Orofac Pain;27:256-62

Kolokythas A, Olech E, Miloro M (2010). Alveolar osteitis: a comprehensive review of concepts and controversies. Int J Dent. 2010;2010:249073

Ricardo Pedro da Silva (2020). Is ozone effective in reducing pain, edema, and trismus after third molar surgery? A systematic review. Research, Society and Development, v. 9, n. 10, e319108407.

Rang HP, Dale MM, RitterJM. Pharmacology.3 ed,Edinburgh: Churchill Livingstone, 1995.

Kim K, Brar P, Jakubowski J (2009). The use of corticosteroids and nonsteroidal anti- inflammatory medication for the management of pain and inflammation after third molar surgery: A review of the literature. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 107:630,

Bello SA, AdeyemoWL, Bamgbose BO, Obi EV, Adeyinka AA. Effect of age, impaction types and operative time on inflammatory tissue reactions following third molar surgery. Head Face Med. 2011 Apr 28;7;8.

Kazancioglu HO, Kurklu E, Ezirganli S (2014). Effects of ozone therapy on pain, swelling, and trismus following third molar surgery. Int J Oral Maxillofac Surg. 43: 644.

Shokry M , Alshaimaa S (2016). Effect of xenograft-ozonated gel mixture on alveolar bone healing following removal of impacted third molar: A randomized controlled clinical trial. Egypt Dent J .;62(4):4749-57

Shulman DH, Shipman B, Willis FB(2009). Treating trismus with dynamic splinting: A case report. J Oral Sci. 2009;51:141–4.

Malamed SF (2008) handbook of Local Anaesthesia.5th ed.2008 pp105-6

Erdemci F, Gunaydin Y, Sencimen M, Bassorgun I, Ozler M, Oter S, et al. (2014). Histomorphometric evaluation of the effect of systemic and topical ozone on alveolar bone healing following tooth extraction in rats. Int J Oral Maxillofac Surg.;43(6):777–83

George Broughton II, Janis JE, Attinger CE (2006). The basic science of wound

healing. Plast. Reconstr. Surg. Jun 1;117(7S):12S-34S

Seidler V., Linetskiy I., Hubalkova H., (2008). Ozone and Its Usage in General Medicine and Dentistry-A Review article. Prague Med Rep. 109:5,.

A SR, Reddy N, Dinapadu S, Reddy M, Pasari S (2013). Role of ozone therapy in minimal intervention dentistry and endodontics - a review. J Int Oral Health. Jun;5(3):102 8.Pubmed PMID: 24155611.

Shiratori R, Kaneko Y, Kobayashi Y, Yamamoto Y, Sano H, Ishizu Y, et al (1993). Can ozone administration activate the tissue metabolism?--A study on brain metabolism during hypoxic hypoxia. Masui. Jan;42(1):2-6.Pubmed PMID: 8433487

Oosting RS, Van Rees-Verhoef M, Verhoef J, Van Golde LM, Van Bree L (1991). Effects of ozone on cellular ATP levels in rat and mouse alveolar macrophages. Toxicology.;70(2):195-202.Pubmed PMID: 1763414.

Bocci V, Luzzi E, Corradeschi F, Silvestri S (1994). Studies on the biological effects of ozone: 6. Production of transforming growth factor 1 by human blood after ozone treatment. J Biol Regul Homeost Agents. OctDec;8(4):108-12.

Martínez-Sánchez G, Al-Dalain SM, Menéndez S, Re L, Giuliani A, Candelario-Jalil E, et al(2005). Therapeutic efficacy of ozone in patients with diabetic foot. Eur J Pharmacol. Oct 31;523(1-3):151-61.

Filippi A (2001). The influence of ozonised water on the epithelial wound healing process in the oral cavity. Clinic of Oral Surgery, Radiology and Oral Medicine, University of Basel, Switzerldand .

Fazakerley M, Field EA (1991). Dry socket: A painful post extraction complication:

A review. Dent Update;18:31 4.

Bloomer CR (2000). Alveolar osteitis prevention by immediate placement of

medicated packing. Oral Surg Oral Med Oral Pathol Oral Radiol Endod;90:282 4

SiskAL, HammerWB, Shelton DW, Joy ED Jr. Complication following removal

of impacted third molars: The role of the experience of the surgeon. J Oral

Maxillofac Surg 1986;44:855 9

Osborn TP, Frederickson G, Small IA,Torgerson TS (1985). A prospective study of

complications related to mandibular third molar surgery. J Oral Maxillofac

Surg;43:767 9

Heasman PA, Jacobs DJ (1984).A clinical investigation into the incidence of drv socket.Br J Oral Maxillofac Sura 1984;22:115 22

Meechan JG, Macgregor ID, Rogers SN, Hobson RS, Bate JP, Dennison M (1988).The effect of smoking on immediate post extraction socket filling with blood and the incidence of painful socket. Br J Oral Maxillofac Surg;26:402 9

Catellani JE, Harvey S, Erickson SH, Cherkink D (1980). Effect of oral contraceptive

cycle on dry socket (localized alveolar osteitis). J Am Dent Assoc;101:777 80

Gersel Pedersen N (1977). Blood fibrinolytic activity before and after oral surgery.

Int J Oral Surg 6:42 7

Babar A, Ibrahim MW, Baig NJ, Shah I, Amin E (2012). Efficacy of intra alveolar

chlorhexidine gel in reducing frequency of alveolar osteitis in mandibular

third molar surgery. J Coll Physicians Surg Pak;22:91 4.

Yengopal V, Mickenautsch S (2012). Chlorhexidine for the prevention of alveolar

osteitis. Int J Oral Maxillofac Surg;41:1253 64.

Cruz Guerra O, Menéndez Cepero S, Martínez Jordán ME, VÁZQUEZ C (1997). Aplicación de la ozonoterapia en el tratamiento de la alveolitis. Revista Cubana de Estoma tología .;34(1):21-4.

Ahmedi, J., Ahmedi, E., Sejfija, O., Agani, Z., & Hamiti, V. (2016). Efficiency of gaseous

ozone in reducing the development of dry socket following surgical third molar extraction.

European journal of dentistry, 10(3), 381–385.




How to Cite

Hamadamin SF, Haider AA. Effect of Ozone Gel on Postoperative Sequelae after Surgical Removal of Impacted Lower Third Molars. EDJ [Internet]. 2024 Jun. 6 [cited 2024 Jul. 20];7(1):75-8. Available from: https://edj.hmu.edu.krd/index.php/journal/article/view/273



Original Articles