Ozone therapy for medication-related osteonecrosis of the jaw: a scoping review

To review the existing literature on the use of ozone therapy in the management of medication-related osteonecrosis of the jaw (MRONJ) lesions.

An electronic search was conducted in Medline/PubMed, Web of Science, Cochrane Library, Scopus, and OpenGray databases. The study protocol was registered in the Open Science Framework (OSF) (DOI: 10.17605/OSF.IO/FHAEM). Data extracted from selected works included authorship, year of publication, study design, number of patients and MRONJ lesions, ozone therapy type and protocol, device used, additional treatments, cause of osteonecrosis, mean age, follow-up period, lesion and patient healing success rates, and complications reported.

The initial search identified 194 articles, of which 14 met the inclusion criteria. These studies included 191 patients with 197 MRONJ lesions. Ozone therapy protocols and additional treatments varied widely across studies. Complete mucosal healing and resolution of necrotic lesions without symptoms were observed in 137 of 191 patients (71.73%) and 143 of 197 lesions (72.59%).

Ozone therapy would appear a promising adjunctive treatment for MRONJ, due to its antimicrobial, anti-inflammatory, and tissue-regenerative effects. Nevertheless, further well-designed, large-scale clinical trials with standardized protocols and long-term follow-up periods are needed to confirm its efficacy and define its role in clinical practice.