Ozonized Hydrogel and Chlorhexidine Gel for Peri-Implant Mucositis: A 24-Month Randomized Controlled Trial

Objective: This randomized controlled trial evaluated the 24-month effectiveness of a nonsurgical intervention for peri-implant mucositis, comparing a 15% ozonated sunflower oil hydrogel with a 1% chlorhexidine gel. Methods: Thirty patients with 360 peri-implant mucositis sites were treated in a split-mouth design, receiving both therapies in randomly assigned quadrants. Clinical parameters—probing pocket depth (PPD), plaque index (PI), bleeding on probing (BoP), bleeding score (BS), suppuration index (SI), and marginal mucosal condition (MMC)—were recorded at baseline and nine follow-ups. Marginal bone level (MBL) was measured radiographically at baseline, 6, 15, and 24 months. Recurrence was defined as the reappearance of BoP, SI, or MMC after resolution. Data were analyzed with the Friedman test and Dunn's post hoc. Results: Both treatments produced significant improvements. The ozonated hydrogel achieved faster and greater reductions in BoP, BS, and SI, with significant differences at 6 and 24 months. MBL remained stable in both groups, with no progression to peri-implantitis. No adverse events occurred, and compliance was maintained. Conclusions: The ozonated sunflower hydrogel provided superior anti-inflammatory effects over chlorhexidine, particularly in reducing bleeding and suppuration, while preserving bone stability. Its safety, efficacy, and acceptability support its use as an adjunct in peri-implant mucositis maintenance.