This prospective split-mouth randomized clinical trial was conducted to evaluate the effect of ozone treatment applied to fresh implant sockets on marginal bone levels and bone microarchitecture following immediate implant placement. Each participant received ozone treatment at one implant site and conventional treatment at the contralateral site according to a randomized allocation. Marginal bone levels and bone microarchitecture were evaluated using cone-beam computed tomography (CBCT) and fractal analysis over a 6-month follow-up period.

This prospective split-mouth randomized clinical trial was conducted at the Department of Periodontology, Faculty of Dentistry, Adıyaman University. The study aimed to investigate whether the application of gaseous ozone to fresh implant sockets influences marginal bone levels and bone microarchitecture following immediate implant placement. Fifty participants requiring bilateral implant placement in comparable sites were enrolled. In accordance with the split-mouth design, one implant site received gaseous ozone treatment before implant placement, while the contralateral site served as the control, with treatment allocation determined by computer-generated randomization. Two participants were lost to follow-up, and the final analysis included 48 participants (152 implants). The primary outcome was the change in marginal bone levels after 6 months. Secondary outcomes included changes in bone microarchitecture assessed by fractal analysis of standardized radiographic images. Radiographic evaluations were performed using panoramic radiography and cone-beam computed tomography (CBCT).

Inclusion Criteria:

• Adults aged 18 years or older.
• Systemically healthy individuals.
• Ability to comply with the study protocol.
• At least two missing teeth in symmetrical areas or different quadrants of the same jaw requiring implant placement.
• Adequate alveolar bone volume for placement of standard diameter (3.5-4.0 mm) and length (8-12 mm) implants with at least 1.5 mm of surrounding bone.
• Soft tissue phenotype ≥2 mm and keratinized mucosal width ≥2 mm at implant sites.
• Written informed consent provided.

Exclusion Criteria:

• Systemic diseases contraindicating implant surgery.
• Pregnancy.
• Insufficient alveolar bone volume requiring advanced bone augmentation.
• Active oral infection.
• Previous implant failure at the intended implant site.
• Incomplete healing after recent tooth extraction.
• Advanced periodontal disease.
• Smoking.
• Any contraindication to ozone therapy.

Individual participant data (IPD) will not be shared because no data-sharing plan was established at the time of study design.