How does guided bone regeneration work?
Guided bone regeneration rests on a simple principle: bone graft material is placed into the defect, and a thin membrane covers it so that the space underneath can fill with bone undisturbed. Without a barrier, the faster-healing gum would grow into the defect. The consent information of İzmir Demokrasi University’s dental hospital therefore describes the membrane as a barrier against unwanted tissue growth.
The 2008 consensus statement of the International Team for Implantology (ITI), by Jensen and Terheyden, recommends a membrane whenever granular material is used, because defects then filled more completely. The procedure usually runs like this:
- The area is numbed, the gum is folded back and the bone exposed.
- The material is placed into the defect; if there is enough bone to hold an implant firmly, the implant is placed in the same session.
- The material is covered with a membrane or a titanium mesh.
- The gum is closed without tension and stitched.
What bone grafting is in general, and why the jawbone shrinks after tooth loss, is explained in our guide bone graft before implants. The materials themselves are compared in types of bone grafting. This page is only about the technique with a membrane.
When is guided bone regeneration used?
Most often for small and medium defects where the bone does not fully surround the implant. According to the ITI consensus statement, exposed implant surfaces (dentists call them dehiscences and fenestrations) can be covered with the patient’s own bone or with material of human or animal origin and protected with a membrane. Cambridge University Hospitals explains that this is usually done in the same session as the implant and then needs no extra healing time.
According to the ITI, widening the jaw is more predictable than adding height, which is possible but linked to more complications. For larger defects, greater width gains have been reported with bone blocks; see our guide block bone graft. When height is missing at the back of the upper jaw because of the sinus, a sinus lift is the suitable procedure instead.
Resorbable or non-resorbable membrane: what is the difference?
Resorbable membranes dissolve in the body; non-resorbable membranes and titanium mesh have to be removed in a second small procedure. According to Cambridge University Hospitals, the most commonly used membrane is of porcine (pig) origin and dissolves over time. Ege University’s consent information notes that a non-resorbable membrane is removed in a second minor procedure, while a resorbable one is not.
| Feature | Resorbable membrane | Non-resorbable membrane | Titanium mesh |
|---|---|---|---|
| Material | Usually collagen of animal origin | Synthetic (for example PTFE) | Thin perforated titanium, sometimes custom-made |
| Removal | Not needed | Second procedure | Second procedure |
| What matters for you | Say before planning if you do not want animal-derived material | Removal belongs in the treatment plan | Exposure in around 20 percent in one meta-analysis |
The type of membrane does not seem to change the complication rate: in the systematic review by Tay and colleagues (2020), resorbable and non-resorbable membranes did not differ in how often complications occurred. For travellers, the removal can be combined with the session in which the implant is placed or uncovered.
Is the graft done together with the implant or before it?
For small defects, usually in the same session; for larger ones, in a separate procedure several months before the implant. What decides it is whether the implant can be placed in the right position and sits firmly at placement. According to the ITI (2008), survival rates are high for implants whose exposed surfaces were grafted with a membrane in the same session.
The implant diameter also plays a part. According to the ITI consensus statement on narrow-diameter implants (2018), these can reduce the need for lateral bone grafting and make a one-stage rather than a staged approach more likely. Which implant sizes are suitable for you is assessed at the examination.
What does it mean if the membrane becomes exposed?
An exposed membrane means the gum has opened during healing and the membrane or mesh is visible. According to Tay and colleagues (2020), small wound openings occurred at 9.9 percent of sites in horizontal grafting and were the most frequent complication. For titanium mesh, a 2022 meta-analysis found exposure rates of 19.9 percent for conventional and 15.2 percent for custom-made meshes, without a significant difference.
Exposure can reduce the bone gain. According to the meta-analysis by Garcia and colleagues (2018), the width gain at toothless sites with an exposed membrane was around 76 percent lower than at sites without exposure; for defects around an implant, healing was around 27 percent lower.
If you notice a white, grey or metallic-looking area on the gum, do not touch it and get in touch, even from home. How openings and infections are treated is described in our guide healing after a bone graft.
What other risks are there?
In the review by Tay and colleagues, 16.1 percent of patients had at least one minor complication; major complications, such as persistent infection or removal of the material, were reported in 1.6 percent.
Cambridge University Hospitals lists infection, exposure of the material, failure to heal and too little bone for an implant, with a higher risk in smokers; İzmir Demokrasi University adds pain, swelling, bleeding, temporary or permanent numbness and early removal of an exposed membrane.
How long does healing take, and when is the implant placed?
When the graft is done together with the implant, the material heals alongside the implant and the final teeth follow. In the staged approach, the implant is placed only once the graft has matured. Tay and colleagues suggest reassessing the site after about six months; according to Cambridge University Hospitals, it can take 4 to 12 months for the material to fuse with your own bone.
According to the ITI (2008), survival rates of implants in regenerated bone are comparable with those in natural bone. The overall timeline of implant treatment with and without grafting is explained in our guide how long does dental implant treatment take.
What does this mean for your trips to Türkiye?
For patients travelling from abroad, the number of stays is what matters most:
- One-stage (graft with the implant): usually two stays, one for the implant and graft, one for the teeth after healing.
- Staged (graft first): usually one extra stay, because several months pass between the graft and the implant.
- Non-resorbable membrane or titanium mesh: the removal is combined with an already planned session wherever possible.
A 2023 article in the British Dental Journal gives two weeks as the earliest point to fly after procedures such as bone grafting, provided there is no pain, swelling or bleeding; research is limited, and the decision rests with your dentist. According to Guy’s and St Thomas’ NHS Foundation Trust, stitches after minor bone grafting are removed about one week later, which your dentist at home can usually do; ask before the procedure whether dissolving stitches will be used. How grafting affects your stays is explained in how many days in Türkiye for dental implants.
How do we plan guided bone regeneration at Rönesans?
At our clinic in Serdivan, the width, height and position of the bone defect are assessed in three dimensions on a cone-beam CT (CBCT) scan. We carry out bone grafting and sinus lifts at the clinic, under general anaesthetic if needed. Whether the graft is done in the same session as the implant or separately, and which membrane is suitable, is decided after the examination and CBCT scan; you know from the start who is treating you.
Before treatment begins you receive a written treatment and cost plan listing the procedures for each tooth and the number of stays; transfer from Istanbul and accommodation in Sapanca are included in the treatment price. Before you leave, wound healing is checked and you receive copies of your treatment summary and X-rays for your dentist at home. If you suspect at home that the membrane is exposed, send us photos on WhatsApp at +90 532 363 49 54; how care continues after your return is described on our aftercare and follow-up page.