Guided bone regeneration (GBR) is a surgical technique to rebuild missing alveolar bone, most often before or at the same time as implant treatment. A barrier membrane, usually over a bone substitute material, limits the ingrowth of soft tissue and maintains a stable space where new bone can form. A network meta-analysis of lateral bone augmentation at the same time as implant placement described the results as predictable.
What is guided bone regeneration?
GBR is a surgical technique to rebuild missing alveolar bone. A barrier membrane is placed between the bone defect and the soft tissue above, usually over a bone substitute material. The membrane delimits a space where the bone can regenerate without being displaced by connective tissue.
A narrative literature review published by Marian et al. in the Lithuanian journal Medicina describes GBR as particularly useful for preparing an implant site and for repairing bone defects after trauma, extractions, periodontal disease, or congenital conditions.1
The technique is closely related to GTR (guided tissue regeneration), which uses the same barrier principle around a tooth. How it is done for periodontal defects, we review in the article on the treatment of periodontal bone defects.
How does GBR work?
The principle is based on the fact that cells in healing move at different speeds. This is described by Tang and Zhang in a meta-analysis in Acta Odontologica Scandinavica, which we return to below: Epithelial cells and fibroblasts migrate into a defect faster than bone-forming cells, and the membrane must selectively keep them out without hindering natural wound healing.2
The membrane therefore has two tasks:
- It limits the ingrowth of soft tissue, so that it does not fill the defect before bone formation has started.1
- It holds the space, so that the space under the membrane does not collapse before the bone has filled it out.1
The principle outweighs the product. Calciolari et al. conducted a network meta-analysis in Periodontology 2000 of randomized and controlled clinical trials comparing biomaterials for lateral bone augmentation with GBR at the same time as implant placement, with the bone level measured after at least 12 months. The authors concluded that regeneration in the type of defects was predictable, regardless of which biomaterial was used, as long as the biological principle behind GBR was followed.3
What barrier membranes are there?
The membranes are divided into two main groups depending on whether the body breaks them down. The resorbable ones are further divided by what they are made of.
- Non-resorbable
- Polytetrafluoroethylene (PTFE), either expanded (ePTFE) or high-density PTFE (dPTFE), titanium-reinforced PTFE, and titanium mesh. High mechanical stability and good space maintenance, but must be removed in a new procedure.1
- Resorbable, natural
- Collagen, chitosan, and gelatin. Broken down by the body, but have less mechanical strength.1
- Resorbable, synthetic
- e.g. polylactic acid (PLA), where the degradation time can be adjusted, and polycaprolactone (PCL), which degrades slowly.1
- Resorbable, autologous
- Membranes of platelet-rich fibrin (PRF), which are made from the patient's own blood and pressed into a fibrin membrane. There are several PRF protocols, and the study below used albumin-enriched PRF.4
The review in Medicina describes the trade-off as follows: Non-resorbable membranes provide the mechanical stability required for large defects, and titanium-reinforced dPTFE is highlighted as a preferred choice for large vertical defects. The price is an additional procedure, which increases both the discomfort for the patient and the costs. Resorbable membranes avoid that procedure, but can fail in extensive defects because they do not have the same strength.1
In a preliminary randomized trial in BMC Oral Health, Alsabahi et al. compared immediate implant placement in 20 patients with an albumin-enriched PRF membrane and a synthetic collagen membrane. The PRF group had a better aesthetic score and slightly less marginal bone loss, while the collagen membrane preserved the labial bone thickness better. The authors explained the latter by the fact that the PRF membrane is fragile and can collapse, i.e., the space maintenance. The study had 10 patients per group and no power calculation.4 If PRF is new to you, start with our guide to Platelet-Rich Fibrin.
What does the research show about the membranes?
Tang and Zhang's meta-analysis gathered 11 controlled clinical studies and cohort studies with a total of 1,003 patients who received GBR in connection with implant treatment, and compared resorbable with non-resorbable membranes.2
- The resorbable membranes gave a significantly higher success rate (eight studies) and significantly fewer side effects.
- The thickness of the bone graft and the formed bone was also significantly greater with resorbable membranes. However, the differences between the studies for bone thickness were very large (I² = 94%).
- Histologically, there was no difference in osseointegration or the amount of mineralized tissue. The measurements relied on two studies.
The result should be read with reservations. Four of the studies did not describe how the patients were allocated, none described blinding or dropout in more detail, and some of the funnel diagrams suggested publication bias. The search included Chinese databases, several of the studies are Chinese, and several of them used titanium membranes as the non-resorbable control, so the result does not necessarily say much about PTFE membranes. Not all the trials pointed in the same direction: one of the included studies found greater loss of horizontal bone thickness and more soft tissue dehiscences with the resorbable membrane.2
The network meta-analysis in Periodontology 2000 nuances the picture. The analysis described GBR as safe and predictable, but complications such as membrane exposure, infection, and wound dehiscence were reported, and they tended to be more frequent with cross-linked collagen membranes. Regardless of the material, some of the augmented bone resorbed over time, and there was a tendency for less effect in large defects, although it did not reach statistical significance.3
Resorbable is not one category. The Calciolari analysis's tendency for more complications with cross-linked collagen membranes shows that it can pay to look at the specific membrane and not just the main group.3
When is GBR used?
The sources describe GBR in these situations:
- At the same time as implant placement to cover a fenestration or dehiscence or to shape the contour of the jaw ridge.3
- Before implant treatment, when the bone volume is too small for the implant to be placed.1
- For immediate implant placement with a labial bone defect.4
- For large vertical defects, where a membrane with extra strength, e.g. titanium-reinforced PTFE, may be indicated.1
Directly after an extraction, a related technique is used to preserve the alveolus before bone loss occurs. It is described in the article on socket preservation.
The choice of technique, membrane, and bone material for the individual patient depends on the size and shape of the defect and is the treating dentist's assessment.
What do studies of the membranes in our product range show?
Two of the membranes in our product range, Jason and permamem, have been used in published clinical studies of GBR.
Jason membrane. In a randomized trial in Materials, Lee et al. covered a preformed titanium mesh with either Jason, which is a non-cross-linked collagen membrane, or a cross-linked collagen membrane in dehiscence defects around implants in the front of the upper jaw. In the 28 patients who were evaluated, the horizontal bone gain after six months was 2.27 mm with Jason and 2.44 mm with the cross-linked membrane, without a significant difference. All implants survived. Two of the 30 enrolled patients dropped out because the titanium mesh was exposed.5
The membrane was also followed for a longer time. In a retrospective study in Clinical Implant Dentistry and Related Research, Tatli et al. reviewed 764 implants with an average follow-up of almost six years. All bone augmentations were done with cerabone and Jason membrane. The 127 implants that were placed after GBR had a survival rate of 99.21% and a success rate of 85.04%. For implants placed in bone without augmentation, the numbers were 98.00% and 85.50%. The authors concluded that implants in augmented bone had comparable success and survival rates to implants in bone without augmentation. The study had no group without a membrane and therefore says nothing about the membrane's own significance. The implants in augmented bone overall received a lower aesthetic score (PES).6
The PTFE membrane permamem. Palkovics et al. described in BMC Oral Health eight patients who received vertical bone augmentation with permamem over teltskrues and a mixture of autologous bone and cerabone. After nine months, the jaw ridge was on average 3.80 mm higher, and all implants could be placed without further augmentation. The membrane was exposed in four of the eight cases, and here the vertical gain was 3.55 mm compared to 4.06 mm without exposure.7
The studies are small or retrospective, and only the Lee study is randomized. The findings apply to the specific membranes in the setups that were investigated and cannot be transferred to the entire membrane group.
Membranes in Puredents' product range
Examples of both main groups of membranes:
If you want to work with the technique in practice, see the upcoming courses in biomaterials and surgery.
Frequently asked questions about GBR
What is the difference between GBR and GTR?
GBR (guided bone regeneration) aims to recreate bone, typically in the jaw ridge before or around an implant. GTR (guided tissue regeneration) uses the same barrier principle around a tooth to recreate the tooth's supporting tissue. The technique is related, but the goal is different.
Does a GBR membrane need to be removed again?
It depends on the type. Non-resorbable membranes of PTFE, titanium-reinforced PTFE, or titanium mesh must be removed in a new procedure. Resorbable membranes of e.g. collagen are broken down by the body and do not need to be removed, but they have less mechanical strength and can fail in extensive defects.1
Are resorbable or non-resorbable membranes best?
The evidence does not point to one winner. A meta-analysis in Acta Odontologica Scandinavica with 11 studies and 1,003 patients found a higher success rate and fewer side effects with resorbable membranes, but the methodological quality of the studies was limited.2 A literature review in Medicina highlights titanium-reinforced membranes for large vertical defects, because they have greater mechanical stability.1
Can PRF be used as a membrane in GBR?
PRF can be pressed into an autologous membrane. In a preliminary randomized trial with 20 patients in BMC Oral Health, an albumin-enriched PRF membrane gave a better aesthetic score and slightly less marginal bone loss than a collagen membrane, while the collagen membrane preserved the labial bone thickness better. The authors explained it by the fact that the PRF membrane is fragile. The study is too small for firm conclusions.4
What complications can occur with GBR?
Among the reported complications are membrane exposure, infection, and wound dehiscence. A network meta-analysis in Periodontology 2000 found a tendency for them to be more frequent with cross-linked collagen membranes. The same analysis described that some resorption of the augmented bone is seen over time regardless of the material.3
Sources
- Marian D, Toro G, D'Amico G, et al. Challenges and Innovations in Alveolar Bone Regeneration: A Narrative Review on Materials, Techniques, Clinical Outcomes, and Future Directions. Medicina (Kaunas). 2024;61(1):20. DOI
- Tang H, Zhang Y. Effects of different oral barrier membranes on the efficacy and safety of guided bone regeneration in patients with dental implants: a systematic review and meta-analysis. Acta Odontologica Scandinavica. 2025;84:318-331. DOI
- Calciolari E, Corbella S, Gkranias N, Viganó M, Sculean A, Donos N. Efficacy of biomaterials for lateral bone augmentation performed with guided bone regeneration. A network meta-analysis. Periodontology 2000. 2023;93(1):77-106. DOI
- Alsabahi H, Mowafey B, Kandil I, Elgohary N, Youssef J. Clinical and radiographic evaluation of autologous albumin-rich platelet-rich fibrin membrane versus synthetic collagen membrane for immediate dental implant placement in the maxillary esthetic zone: a preliminary randomized clinical trial. BMC Oral Health. 2026;26:292. DOI
- Lee SR, Jang TS, Seo CS, Choi IO, Lee WP. Hard Tissue Volume Stability Effect beyond the Bony Envelope of a Three-Dimensional Preformed Titanium Mesh with Two Different Collagen Barrier Membranes on Peri-Implant Dehiscence Defects in the Anterior Maxilla: A Randomized Clinical Trial. Materials (Basel). 2021;14(19):5618. DOI
- Tatli U, Cavana A, Tukel HC, Benlidayi ME. Effects of Bone Augmentation on Implant Success and Survival: A Retrospective Analysis With 6-Year Mean Follow-Up. Clinical Implant Dentistry and Related Research. 2025;27(2):e70021. DOI
- Palkovics D, Bolya-Orosz F, Pinter C, Molnar B, Windisch P. Reconstruction of vertical alveolar ridge deficiencies utilizing a high-density polytetrafluoroethylene membrane /clinical impact of flap dehiscence on treatment outcomes: case series/. BMC Oral Health. 2022;22:490. DOI
Share:
What is socket preservation?
PRF membranes: how they are made and what determines their quality