What is guided bone regeneration (GBR)?

When a gap forms in the jawbone, two tissues “compete” to fill it: fast-growing connective tissue and slower-growing bone. Without any precautions, the gap usually fills with soft tissue. The basic idea of GBR is to seal the area with a barrier membrane, keeping the soft tissue out so that the gap is filled only by cells coming from the surrounding bone.

This principle was first described in orthopaedic research and has been used in implant patients since the late 1980s. Today it is a routine and scientifically well-documented part of implant surgery. We describe the types of graft material in detail in our article on bone graft types.

What does the membrane do?

A barrier membrane is expected to have the following properties:

• Biocompatibility: It must not cause inflammation or a foreign-body reaction in the tissues.
• Cell occlusion: It must prevent connective tissue cells from entering the defect.
• Tissue integration: It must stay firmly in place without shifting.
• Space making and maintenance: It must stop the space beneath it from collapsing.
• Easy handling and a low risk of complications.

What is the difference between resorbable and non-resorbable membranes?

Resorbable membranes are mostly made of animal-derived collagen, and some of synthetic polymers. When wetted with blood they soften and adhere to the bone and graft by themselves; over time they are broken down by the body. Their main advantages are that no second surgery is needed to remove them and that the risk of exposure is lower. Their disadvantages are that they are mechanically weak and their barrier effect is short-lived, so a slowly resorbing graft is placed beneath them to prevent collapse.

Non-resorbable membranes (e.g. ePTFE, titanium-reinforced PTFE or titanium mesh) are rigid and can be shaped; in difficult cases such as vertical bone augmentation they protect the space more reliably. However, they must be fixed with screws and removed in a second procedure at the end of healing, and if exposed early, the risk of infection is higher.

Long-standing clinical experience with GBR recommends collagen membranes for most horizontal bone deficiencies and non-resorbable membranes for selected vertical cases.

How is GBR performed?

1. Planning: A clinical examination and a 3D CT scan are used to assess the width and height of the bone and the neighbouring anatomical structures. The ideal implant position for the future prosthesis is determined.
2. Anaesthesia and flap: Under local anaesthesia, the gum is carefully lifted to expose the bone.
3. Preparing the bone surface: If necessary, small holes are drilled in the bone to help blood and cells flow in from the bone marrow.
4. Graft and membrane: The defect is filled with graft material and covered with the membrane.
5. Tension-free closure: The gum is stretched and stitched so that there is no tension on the wound line. This is the most critical step for preventing membrane exposure.

Can GBR be done in the same session as the implant?

The literature recommends performing the implant and GBR in the same session whenever possible, so the patient only has one surgery – a real advantage if you are travelling to Istanbul for treatment. Three conditions must be met:

• The implant can be placed in the correct three-dimensional position for function and aesthetics,
• The implant achieves sufficient primary stability in that position,
• The shape of the bone defect is favourable; ideally, there are at least two bone walls next to the implant.

If the bone is very thin, the defect has only one wall or vertical augmentation is required, GBR or a block graft is performed first and the implant is placed once the bone has matured (staged approach).

What is the difference between GBR and a block bone graft?

GBR mostly uses particulate grafts, with the membrane maintaining the volume. When bone width is severely reduced, a small block of the patient’s own bone can be fixed with screws in the deficient area. Block grafts are the only graft type that provides mechanical resistance to pressure from the overlying soft tissue. In current practice, the surface of a block graft is usually also covered with slowly resorbing granules and a collagen membrane to limit resorption of the block over time. In other words, block grafts and GBR are often not alternatives but complementary techniques.

What should you pay attention to after GBR?

• Apply a cold compress at intervals for the first 24–48 hours and sleep with your head slightly raised.
• Take the prescribed medication and antiseptic mouthwash for the recommended period.
• Do not pull your lip to look at the stitches; this strains the wound line.
• Eat lukewarm, soft foods in the first week and avoid hard and crunchy foods.
• Avoid strenuous sport and bending or heavy work for a few days.
• Do not miss your follow-up appointments; a small wound opening detected early can usually be managed easily.

Who is it suitable for, and who needs extra caution?

Most healthy adults who are planning implants and have insufficient bone volume are suitable for GBR. Healing potential can be influenced by age, systemic diseases (especially uncontrolled diabetes), smoking and certain medications that affect bone metabolism (e.g. bisphosphonates). These conditions do not always prevent treatment, but they may change the plan.

What are the healing process and risks after GBR?

Swelling and tenderness are expected for the first 2–3 days; stitches are usually removed within 10–14 days. Maturation of the graft can take from a few months to six months or longer, depending on the size of the defect.

• Membrane exposure: Especially with non-resorbable membranes, this can lead to infection and reduced bone gain; tell your dentist immediately.
• Infection: Increasing pain, a bad smell or discharge are warning signs.
• Less bone gain than expected: An additional graft or a different implant plan may be needed.

Frequently asked questions

Related pages

Medically reviewed by: Dr. Dt. Mehmet Fuat BozabaSpecialist in periodontology · September 2026

For an examination and assessment: Message us on WhatsApp or call 0544 289 66 33. Yayla Dental Akademi, Bahçelievler / Istanbul.

Sources: Buser D (ed). 20 Years of Guided Bone Regeneration in Implant Dentistry, 2nd ed. Quintessence Publishing, 2009; Hupp JR, Ellis E III, Tucker MR. Contemporary Oral and Maxillofacial Surgery, 6th ed. Elsevier Mosby, 2014; Misch CE. Contemporary Implant Dentistry, 3rd ed. Mosby Elsevier, 2008.

This article is for information only; a diagnosis and treatment plan can only be made by a dentist after an examination.