Advances in barrier membranes for guided bone regeneration in oral applications

doi:10.12337/zgkqzzxzz.2025.06.014

Abstract

Abstract: Guided bone regeneration (GBR) has become a standard clinical approach for the treatment of localized jawbone defects. In this process, barrier membranes play an important role by preventing the migration of soft tissue from the mucosal side into the bone defect area, thereby maintaining a secluded space for bone regeneration. The biological properties and clinical performance of different membranes vary depending on their origin, fabrication methods, and structural characteristics. This paper summarizes the biological functions and mechanisms of commonly used barrier membranes in GBR, with a particular focus on the properties of different membrane types. The advantages and limitations of these biomaterials are discussed, along with their clinical applications and potential directions for future material development.

Key words: Guided bone regeneration, Resorbable membranes, Polytetrafluoroethylene, Titanium, Immune response, Vascularization

Li Guangda, Ding Mingchao, Chang Xin, Jing Boya, Wang Jingfu, Wang Weiqi. Advances in barrier membranes for guided bone regeneration in oral applications[J]. Chinese Journal of Oral Implantology, 2025, 30(3): 288-295.

References

[1] Kofina V, Monfaredzadeh M, Rawal SY, et al.Patient-reported outcomes following guided bone regeneration: correlation with clinical parameters[J]. J Dent, 2023, 136:104605. DOI: 10.1016/j.jdent.2023.104605.
[2] Omar O, Elgali I, Dahlin C, et al.Barrier membranes: more than the barrier effect?[J]. J Clin Periodontol, 2019, 46(Suppl 21):S103-S123. DOI: 10.1111/jcpe.13068.
[3] Elgali I, Turri A, Xia W, et al.Guided bone regeneration using resorbable membrane and different bone substitutes: early histological and molecular events[J]. Acta Biomater, 2016, 29:409-423. DOI: 10.1016/j.actbio.2015.10.005.
[4] Lima LL, Gonçalves PF, Sallum EA, et al.Guided tissue regeneration may modulate gene expression in periodontal intrabony defects: a human study[J]. J Periodontal Res, 2008, 43(4):459-464. DOI: 10.1111/j.1600-0765.2008.01094.x.
[5] Elgali I, Omar O, Dahlin C, et al.Guided bone regeneration: materials and biological mechanisms revisited[J]. Eur J Oral Sci, 2017, 125(5):315-337. DOI: 10.1111/eos.12364.
[6] Turri A, Elgali I, Vazirisani F, et al.Guided bone regeneration is promoted by the molecular events in the membrane compartment[J]. Biomaterials, 2016, 84:167-183. DOI: 10.1016/j.biomaterials.2016.01.034.
[7] Kitaori T, Ito H, Schwarz EM, et al.Stromal cell-derived factor 1/CXCR4 signaling is critical for the recruitment of mesenchymal stem cells to the fracture site during skeletal repair in a mouse model[J]. Arthritis Rheum, 2009, 60(3):813-823. DOI: 10.1002/art.24330.
[8] Xing Z, Lu C, Hu D, et al.Multiple roles for CCR2 during fracture healing[J]. Dis Model Mech, 2010, 3(7-8):451-458. DOI: 10.1242/dmm.003186.
[9] Giragosyan K, Chenchev I, Ivanova V, et al.Immunological response to nonresorbable barrier membranes used for guided bone regeneration and formation of pseudo periosteum: a narrative review[J]. Folia Med (Plovdiv), 2022, 64(1):13-20. DOI: 10.3897/folmed.64.e60553.
[10] Gou M, Wang H, Xie H, et al.Macrophages in guided bone regeneration: potential roles and future directions[J]. Front Immunol, 2024, 15:1396759. DOI: 10.3389/fimmu.2024.1396759.
[11] Maiti S, Shaw S, Shit GC.Reply to the comments on the article "fractional order model of thermo-solutal and magnetic nanoparticles transport for drug delivery applications" published in colloids and surfaces B: biointerfaces, 203(2021)111754[J]. Colloids Surf B Biointerfaces, 2023, 222:113107. DOI:10.1016/j.colsurfb.2022.113107.
[12] Herten M, Jung RE, Ferrari D, et al.Biodegradation of different synthetic hydrogels made of polyethylene glycol hydrogel/RGD-peptide modifications:an immunohistochemical study in rats[J]. Clin Oral Implants Res, 2009, 20(2):116-125. DOI: 10.1111/j.1600-0501.2008.01622.x.
[13] Barbeck M, Lorenz J, Kubesch A, et al.Porcine dermis-derived collagen membranes induce implantation bed vascularization via multinucleated giant cells:a physiological reaction?[J]. J Oral Implantol, 2015, 41(6):e238-e251. DOI: 10.1563/aaid-joi-D-14-00274.
[14] Kapogianni E, Alkildani S, Radenkovic M, et al.The early fragmentation of a bovine dermis-derived collagen barrier membrane contributes to transmembraneous vascularization-a possible paradigm shift for guided bone regeneration[J]. Membranes (Basel), 2021, 11(3):185. DOI: 10.3390/membranes11030185.
[15] Lindner C, Alkildani S, Stojanovic S, et al.In vivo biocompatibility analysis of a novel barrier membrane based on bovine dermis-derived collagen for guided bone regeneration (GBR)[J]. Membranes (Basel), 2022, 12(4):378. DOI: 10.3390/membranes12040378.
[16] Caballé-Serrano J, Abdeslam-Mohamed Y, Munar-Frau A, et al.Adsorption and release kinetics of growth factors on barrier membranes for guided tissue/bone regeneration: a systematic review[J]. Arch Oral Biol, 2019, 100:57-68. DOI: 10.1016/j.archoralbio.2019.02.006.
[17] Ghensi P, Stablum W, Bettio E, et al.Management of the exposure of a dense PTFE (d-PTFE) membrane in guided bone regeneration (GBR): a case report[J]. Oral Implantol (Rome), 2017, 10(3):335-342. DOI: 10.11138/orl/2017.10.3.335.
[18] Lim G, Lin GH, Monje A, et al.Wound healing complications following guided bone regeneration for ridge augmentation: a systematic review and meta-analysis[J]. Int J Oral Maxillofac Implants, 2018, 33(1):41-50. DOI: 10.11607/jomi.5581.
[19] Urban IA, Montero E, Amerio E, et al.Techniques on vertical ridge augmentation: indications and effectiveness[J]. Periodontol 2000, 2023, 93(1):153-182. DOI: 10.1111/prd.12471.
[20] Gao Y, Wang S, Shi B, et al.Advances in modification methods based on biodegradable membranes in guided bone/tissue regeneration: a review[J]. Polymers (Basel), 2022, 14(5):871. DOI: 10.3390/polym14050871.
[21] Park YW, Kim SG.Comparison of physical property and in vivo bioactivity: silkworm-cocoon-derived silk membrane, collagen membrane, and polytetrafluoroethylene membrane for guided bone regeneration[J]. J Oral Maxillofac Surg, 2014,72(9):e206.DOI:10.1016/j.joms.2014. 06.370.
[22] Zhang M, Zhou Z, Yun J, et al.Effect of different membranes on vertical bone regeneration: a systematic review and network meta-analysis[J]. Biomed Res Int, 2022, 2022:7742687. DOI: 10.1155/2022/7742687.
[23] Ma FB, Xia XY, Tang B.Strontium chondroitin sulfate/silk fibroin blend membrane containing microporous structure modulates macrophage responses for guided bone regeneration[J]. Carbohydr Polym, 2019, 213:266-275. DOI: 10.1016/j.carbpol.2019.02.068.
[24] Wang Y, Yang Z, Chen X, et al.Silk fibroin hydrogel membranes prepared by a sequential cross-linking strategy for guided bone regeneration[J]. J Mech Behav Biomed Mater, 2023, 147:106133. DOI: 10.1016/j.jmbbm.2023.106133.
[25] Jazayeri HE, Tahriri M, Razavi M, et al.A current overview of materials and strategies for potential use in maxillofacial tissue regeneration[J]. Mater Sci Eng C Mater Biol Appl, 2017, 70(Pt 1):913-929. DOI: 10.1016/j.msec.2016.08.055.
[26] Tsai SW, Yu WX, Huang PA, et al.Fabrication and characteristics of PCL membranes containing strontium-substituted hydroxyapatite nanofibers for guided bone regeneration[J]. Polymers (Basel), 2019, 11(11):1761. DOI: 10.3390/polym11111761.
[27] Kubásek J, Vojtěch D, Jablonská E, et al.Structure, mechanical characteristics and in vitro degradation, cytotoxicity, genotoxicity and mutagenicity of novel biodegradable Zn-Mg alloys[J]. Mater Sci Eng C Mater Biol Appl, 2016, 58:24-35. DOI: 10.1016/j.msec.2015.08.015.
[28] Zhang Y, Yan Y, Xu X, et al.Investigation on the microstructure, mechanical properties, in vitro degradation behavior and biocompatibility of newly developed Zn-0.8%Li-(Mg, Ag) alloys for guided bone regeneration[J]. Mater Sci Eng C Mater Biol Appl, 2019,99:1021-1034. DOI: 10.1016/j.msec.2019.01.120.
[29] Yu Z, Yu S, Laijun L, et al.Construction of ultrasmooth PTFE membrane for preventing bacterial adhesion and cholestasis[J]. Colloids Surf B Biointerfaces, 2022, 213:112332. DOI: 10.1016/j.colsurfb.2022.112332.
[30] Kameda T, Ohkuma K, Oka S.Polytetrafluoroethylene (PTFE): a resin material for possible use in dental prostheses and devices[J]. Dent Mater J, 2019, 38(1):136-142. DOI: 10.4012/dmj.2018-088.
[31] Sattar MM, Patel M, Alani A.Clinical applications of polytetrafluoroethylene (PTFE) tape in restorative dentistry[J]. Br Dent J, 2017, 222(3):151-158. DOI: 10.1038/sj.bdj.2017.110.
[32] Leech J, Golub S, Allan W, et al.Non-pathogenic escherichia coli biofilms: effects of growth conditions and surface properties on structure and curli gene expression[J]. Arch Microbiol, 2020, 202(6):1517-1527. DOI: 10.1007/s00203-020-01864-5.
[33] Korzinskas T, Jung O, Smeets R, et al.In vivo analysis of the biocompatibility and macrophage response of a non-resorbable PTFE membrane for guided bone regeneration[J]. Int J Mol Sci, 2018, 19(10):2952. DOI: 10.3390/ijms19102952.
[34] Tan X, Rodrigue D.A review on porous polymeric membrane preparation. Part II: production techniques with polyethylene, polydimethylsiloxane, polypropylene, polyimide, and polytetrafluoroethylene[J]. Polymers (Basel), 2019,11(8):1310. DOI: 10.3390/polym11081310.
[35] Soldatos NK, Stylianou P, Koidou VP, et al.Limitations and options using resorbable versus nonresorbable membranes for successful guided bone regeneration[J]. Quintessence Int, 2017, 48(2):131-147. DOI: 10.3290/j.qi.a37133.
[36] Calciolari E, Corbella S, Gkranias N, et al.Efficacy of biomaterials for lateral bone augmentation performed with guided bone regeneration. A network meta-analysis[J]. Periodontol 2000, 2023, 93(1):77-106. DOI: 10.1111/prd.12531.
[37] Vroom MG, Gründemann LJ, Gallo P.Clinical classification of healing complications and management in guided bone regeneration procedures with a nonresorbable d-PTFE membrane[J]. Int J Periodontics Restorative Dent, 2022, 42(3):419-427. DOI: 10.11607/prd.5590.
[38] Elshahat A, Inoue N, Marti G, et al.Role of guided bone regeneration principle in preventing fibrous healing in distraction osteogenesis at high speed: experimental study in rabbit mandibles[J]. J Craniofac Surg, 2004, 15(6):916-921. DOI: 10.1097/00001665-200411000-00005.
[39] Windisch P, Orban K, Salvi GE, et al.Vertical-guided bone regeneration with a titanium-reinforced d-PTFE membrane utilizing a novel split-thickness flap design: a prospective case series[J]. Clin Oral Investig, 2021, 25(5):2969-2980. DOI: 10.1007/s00784-020-03617-6.
[40] Cucchi A, Vignudelli E, Napolitano A, et al.Evaluation of complication rates and vertical bone gain after guided bone regeneration with non-resorbable membranes versus titanium meshes and resorbable membranes. A randomized clinical trial[J]. Clin Implant Dent Relat Res, 2017, 19(5):821-832. DOI: 10.1111/cid.12520.
[41] Lisoń-Kubica J, Taratuta A, Goldsztajn K, et al.Modern methods of surface modification for new-generation titanium alloys[J]. Acta Bioeng Biomech, 2022, 24(4):147-158.
[42] 宿玉成,任斌. 3D 打印个性化钛网支撑的引导骨再生术后钛网暴露的原因、预防与治疗[J]. 中国口腔种植学杂志, 2025,30(1):5-12. DOI: 10.12337/zgkqzzxzz. 2025. 02.003.
Su YC, Ren B.Causes, prevention and treatment of titanium mesh exposure after 3D printing individualized titanium mesh supported guided bone regeneration[J]. Chin J Oral Implantol, 2025, 30(1): 5-12.DOI: 10.12337/zgkqzzxzz.2025.02.003.
[43] 熊振杰,魏永祥,刘倩,等. 3D打印个性化钛网用于修复严重牙槽骨缺损的临床效果——一项回顾性病例系列研究[J]. 中国口腔种植学杂志, 2025, 30(1): 27-34. DOI: 10.12337/zgkqzzxzz.2025.02.006.
Xiong ZJ, Wei YX, Liu Q, et al.Clinical outcomes of 3D printing individualized titanium mesh for severe alveolar bone defects: a retrospective series[J]. Chin J Oral Implantol, 2025, 30(1): 27-34.DOI: 10.12337/zgkqzzxzz.2025.02.006.
[44] Cucchi A, Vignudelli E, Franceschi D, et al.Vertical and horizontal ridge augmentation using customized CAD/CAM titanium mesh with versus without resorbable membranes.A randomized clinical trial[J]. Clin Oral Implants Res, 2021, 32(12):1411-1424. DOI: 10.1111/clr.13841.
[45] Li S, Zhao J, Xie Y, et al.Hard tissue stability after guided bone regeneration: a comparison between digital titanium mesh and resorbable membrane[J]. Int J Oral Sci, 2021, 13(1):37. DOI: 10.1038/s41368-021-00143-3.
[46] Bai L, Ji P, Li X, et al.Mechanical characterization of 3D-printed individualized Ti-mesh (membrane) for alveolar bone defects[J]. J Healthc Eng, 2019, 2019:4231872. DOI: 10.1155/2019/4231872.
[47] Cucchi A, Vignudelli E, Fiorino A, et al.Vertical ridge augmentation (VRA) with Ti-reinforced d-PTFE membranes or Ti meshes and collagen membranes: 1-year results of a randomized clinical trial[J]. Clin Oral Implants Res, 2021, 32(1):1-14. DOI: 10.1111/clr.13673.
[48] Ovcharenko N, Greenwell H, Katwal D, et al.A comparison of the effect of barrier membranes on clinical and histologic hard and soft tissue healing with ridge preservation[J]. Int J Periodontics Restorative Dent, 2020, 40(3):365-371. DOI: 10.11607/prd.4120.
[49] Yang F, Xu L, Guo G, et al.Visible light-induced cross-linking of porcine pericardium for the improvement of endothelialization, anti-tearing, and anticalcification properties[J]. J Biomed Mater Res A, 2022, 110(1):31-42. DOI: 10.1002/jbm.a.37263.
[50] Kumari C, Ramakrishnan T, Devadoss P, et al.Use of collagen membrane in the treatment of periodontal defects distal to mandibular second molars following surgical removal of impacted mandibular third molars: a comparative clinical study[J]. Biology (Basel), 2021, 10(12):1348. DOI: 10.3390/biology10121348.
[51] Chen W, Liu K, Liao X, et al.Harmonizing thickness and permeability in bone tissue engineering: a novel silk fibroin membrane inspired by spider silk dynamics[J]. Adv Mater, 2024, 36(13):e2310697. DOI: 10.1002/adma.202310697.
[52] Caballé-Serrano J, Sawada K, Miron RJ, et al.Collagen barrier membranes adsorb growth factors liberated from autogenous bone chips[J]. Clin Oral Implants Res, 2017, 28(2):236-241. DOI: 10.1111/clr.12789.
[53] Gielkens PF, Schortinghuis J, de Jong JR, et al. Vivosorb, Bio-Gide, and Gore-Tex as barrier membranes in rat mandibular defects: an evaluation by microradiography and micro-CT[J]. Clin Oral Implants Res, 2008, 19(5):516-521. DOI: 10.1111/j.1600-0501.2007.01511.x.
[54] Sela MN, Babitski E, Steinberg D, et al.Degradation of collagen-guided tissue regeneration membranes by proteolytic enzymes of Porphyromonas gingivalis and its inhibition by antibacterial agents[J]. Clin Oral Implants Res, 2009, 20(5):496-502. DOI: 10.1111/j.1600-0501.2008.01678.x.
[55] Troy E, Tilbury MA, Power AM, et al.Nature-based biomaterials and their application in biomedicine[J]. Polymers (Basel), 2021, 13(19):3321. DOI: 10.3390/polym13193321.
[56] Tavelli L, McGuire MK, Zucchelli G, et al. Extracellular matrix-based scaffolding technologies for periodontal and peri-implant soft tissue regeneration[J]. J Periodontol, 2020, 91(1):17-25. DOI: 10.1002/JPER.19-0351.
[57] Chatterjee S, G K. A Novel candidate for guided tissue regeneration: chitosan and eggshell membrane[J]. Cureus, 2023, 15(11):e48930. DOI: 10.7759/cureus.48930.
[58] Zou S, Yao X, Shao H, et al.Nonmulberry silk fibroin-based biomaterials: Impact on cell behavior regulation and tissue regeneration[J]. Acta Biomater, 2022, 153:68-84. DOI: 10.1016/j.actbio.2022.09.021.
[59] Saleem M, Rasheed S, Yougen C.Silk fibroin/hydroxyapatite scaffold: a highly compatible material for bone regeneration[J]. Sci Technol Adv Mater, 2020, 21(1):242-266. DOI: 10.1080/14686996.2020.1748520.
[60] Song JM, Shin SH, Kim YD, et al.Comparative study of chitosan/fibroin-hydroxyapatite and collagen membranes for guided bone regeneration in rat calvarial defects: micro-computed tomography analysis[J]. Int J Oral Sci, 2014, 6(2):87-93. DOI: 10.1038/ijos.2014.16.
[61] Xie X, Shi X, Wang S, et al.Effect of attapulgite-doped electrospun fibrous PLGA scaffold on pro-osteogenesis and barrier function in the application of guided bone regeneration[J]. Int J Nanomedicine, 2020, 15:6761-6777. DOI: 10.2147/IJN.S244533.
[62] Castro A, Diba M, Kersten M, et al.Development of a PCL-silica nanoparticles composite membrane for guided bone regeneration[J]. Mater Sci Eng C Mater Biol Appl, 2018, 85:154-161. DOI: 10.1016/j.msec.2017.12.023.
[63] Rahman M, Dutta NK, Roy Choudhury N.Magnesium alloys with tunable interfaces as bone implant materials[J]. Front Bioeng Biotechnol, 2020, 8:564. DOI: 10.3389/fbioe.2020.00564.
[64] Dutta S, Gupta S, Roy M.Recent developments in magnesium metal-matrix composites for biomedical applications: a review[J]. ACS Biomater Sci Eng, 2020, 6(9):4748-4773. DOI: 10.1021/acsbiomaterials. 0c00678.
[65] Chen K, Wang Y, Tang H, et al.Fabrication of a nanoscale magnesium/copper metal-organic framework on Zn-based guided bone generation membranes for enhancing osteogenesis, angiogenesis, and bacteriostasis properties[J]. ACS Appl Mater Interfaces, 2024,16(5):5648-5665. DOI: 10.1021/acsami.3c16970.
[66] 任立志, 孙睿. 引导骨再生屏障膜材料临床应用进展[J].口腔疾病防治, 2020, 28(6):404-408.DOI: 10.12016/j.issn.2096-1456.2020.06.012.
Ren LZ,Sun R.New progress in the clinical application of GBR membrane materials[J]. J Prev Treat Stomatol Dis,2020, 28(6):404-408. DOI: 10.12016/j.issn.2096-1456.2020.06.012.
[67] Urban IA, Montero E, Monje A, et al. Effectiveness of vertical ridge augmentation interventions: a systematic review and meta-analysis[J]. J Clin Periodontol, 2019,46 Suppl 21:319-339. DOI: 10.1111/jcpe.13061.
[68] Urban I.Vertical and horizontal ridge augmentation: new perspectives[M]. Berlin: Quintessenz Publishing, 2017:117-118.
[69] Windisch P, Orban K, Salvi GE, et al.Vertical-guided bone regeneration with a titanium-reinforced d-PTFE membrane utilizing a novel split-thickness flap design: a prospective case series[J]. Clin Oral Investig, 2021, 25(5):2969-2980. DOI: 10.1007/s00784-020-03617-6.
[70] 《中国口腔种植学杂志》编辑部. 钛网支撑的引导骨再生的专家共识[J]. 中国口腔种植学杂志, 2024, 29(2):95-100. DOI: 10.12337/zgkqzzxzz.2024.04.001.
Editorial Board of Chinese Journal of Oral Implantology. Expert consensus on titanium mesh supported guided bone regeneration[J]. Chin J Oral Implant, 2024, 29(2): 95-100.DOI: 10.12337/zgkqzzxzz.2024. 04.001.
[71] Alavi SE, Gholami M, Shahmabadi HE, et al.Resorbable GBR scaffolds in oral and maxillofacial tissue engineering: design, fabrication, and applications[J]. J Clin Med, 2023, 12(22):6962. DOI: 10.3390/jcm12226962.
[72] Wan S, Chen Y, Huang C, et al.Scalable ultrastrong MXene films with superior osteogenesis[J]. Nature, 2024,634(8036):1103-1110. DOI: 10.1038/s41586-024-08067-8.
[73] Zhu K, Li R, Yin S, et al.A novel ultrasound-driven piezoelectric GBR membrane dispersed with boron nitride nanotubes promotes bone regeneration and anti-bacterial properties[J]. Mater Today Bio, 2025, 30:101418. DOI: 10.1016/j.mtbio.2024.101418.