I. Disclaimer

This document is intended to be used as a reference for VA and non-VA providers. It is not intended to replace clinical judgment when determining care pathways. These guidelines do not guarantee benefits or constitute medical advice.

Eligibility for VA dental care is defined by statute and is to be provided in accordance with the provisions of existing law and VA regulations, specifically 38 U.S.C. §§1710(c) and 1712, and 38 CFR §§17.160 through 17.166.

II. Dental Clinical Determinations and Indications

1. Indications for Dental Barrier Membrane Guided Tissue Regeneration
2. Dental barrier membrane guided tissue regeneration (GTR) may be considered clinically necessary when ALL the following criteria are met and documented by the treating or referring provider:
   • Defect morphology: Evidence of favorable defect morphology such as two-wall or greater defects
   • Patient compliance: Demonstrated adherence to periodontal maintenance protocols and satisfactory oral hygiene practices
   • Systemic health: Presence of controlled systemic conditions that do not contraindicate periodontal surgery
4. Indications and clinical criteria that may be considered clinically necessary include the following:
   • Periodontal Intrabony Defects: Treatment of 1-, 2-, or 3-wall intrabony defects to regenerate periodontal ligament, cementum, and alveolar bone, confirmed by radiographic evidence of bone loss
   • Grade II Furcation Defects: Management of Grade II furcation involvement to improve clinical attachment levels and promote defect fill
   • Alveolar Ridge Preservation: Placement of barrier membranes following tooth extraction to minimize horizontal and vertical ridge resorption and facilitate future prosthetic or implant placement
   • Ridge Augmentation or Reconstruction: Augmentation or reconstruction of deficient alveolar ridges to achieve adequate bone volume for prosthetic or implant-supported restorations
   • Peri-implant Defects: Treatment of peri-implant bone loss to enhance implant stability and longevity
   • Endodontic Surgical Defects: Management of significant bone loss (e.g., through-and-through lesions) in conjunction with periradicular surgery, confirmed by radiographic evidence of bone loss

2. Limitations/Exclusions
3. Dental barrier membrane GTR is not indicated and therefore considered not clinically necessary when the following conditions are present:
   • Hopeless prognosis teeth: Teeth with severe periodontal attachment loss or non-restorable defects that cannot be maintained
   • Unfavorable defect morphology: Sites with inadequate bone anatomy, such as defects with less than two bony walls (e.g., crater-type defects), which do not support regenerative potential
   • Purely endodontic periapical lesions: Periapical lesions without bone dehiscence or significant periodontal involvement
   • Grade III furcation defects: Advanced furcation involvement where regeneration is predictably unsuccessful
   • Uncontrolled systemic conditions: Conditions that impair wound healing, including but not limited to uncontrolled diabetes, autoimmune disorders, chronic corticosteroid use, or immunosuppressive medication use
   • Poor oral hygiene: Documented inability or willingness to maintain adequate oral hygiene
   • Non-compliance: Documented inability or willingness to adhere to prior periodontal therapies
   • Active tobacco use: Current smoking or tobacco use, which reduces regenerative outcomes
   • Cosmetic or aesthetic use: Procedures aimed solely at improving gingival contour without functional necessity

For all other conditions or indications not listed in section II.a. of this document, dental barrier membrane GTR is considered not clinically necessary due to insufficient evidence of efficacy and safety.

3. Description of Treatment
4. Dental barrier membrane GTR is a procedure to help rebuild bone and gum tissue around teeth or dental implants, making them stronger and more stable. This procedure is typically done using local anesthesia and in more complex cases, general anesthesia or IV sedation may be used. The surgeon gently accesses the area of bone loss and places a special membrane, which acts like a shield to protect the healing site. This membrane can be resorbable (made of materials like collagen that dissolve on its own) or non-resorbable (made of materials like Polytetrafluoroethylene (PTFE), removed in a follow-up visit). Often, bone graft material is added to encourage new bone growth. This procedure is used to repair bone damaged by gum disease, maintain jawbone shape after a tooth is removed, support dental implants, or fix bone loss during root canal surgery.

III. Background and Supporting Information

The following information is for reference purposes only in accordance with dental eligibility as defined by statute (law). Each subsection supports VA’s determinations for clinical necessity and alignment with generally accepted standards of dental practice.

1. Background Information
2. Dental barrier membrane guided tissue regeneration (GTR) is a cornerstone of periodontal and implant dentistry, enabling the regeneration of periodontal ligament, cementum, and alveolar bone in areas of bone loss. By using resorbable or non-resorbable membranes to selectively guide cell growth, GTR addresses intrabony defects, furcation involvements, ridge deficiencies, and peri-implant bone loss. Often combined with bone grafts, GTR enhances outcomes for periodontal health, implant stability, and prosthetic function, improving patient oral health and quality of life through minimally invasive, evidence-based techniques.

2. Research, Clinical Trials, and Evidence Summaries
3. The efficacy and safety of GTR are supported by extensive clinical literature. Nibali et al. (2021) in the Journal of Clinical Periodontology demonstrated significant improvements in clinical attachment level (CAL) and bone fill in intrabony defects treated with GTR. Swami et al. (2021) in Clinical Oral Investigations report better CAL and horizontal defect fill in Grade II furcation defects with GTR compared to bone grafting alone. Avila-Ortiz et al. (2019) and Bassir et al. (2018) in the Journal of Clinical Periodontology and International Journal of Oral and Maxillofacial Implants show that GTR with bone grafts reduces alveolar ridge resorption post-extraction, minimizing future augmentation needs. Parmar et al. (2019) and Tsesis et al. (2011) in the International Endodontic Journal and Journal of Endodontics confirm enhanced radiographic healing in endodontic surgery with GTR for through-and-through lesions. Soldatos et al. (2017) in Quintessence International highlight lower complication rates with resorbable membranes, while Trobos et al. (2018) in Clinical Implant Dentistry and Related Research note superior bacterial occlusion with dense Polytetrafluoroethylene (PTFE) membranes. Outcomes are influenced by defect morphology, membrane fixation, systemic health, and patient compliance (Bashutski et al., 2011; Beyene et al., 2020). These studies provide a robust evidence base through systematic reviews, meta-analyses, and clinical trials, justifying GTR indications.

3. U.S. Food & Drug Administration Information
4. VA generally only approves use of medical devices that have received at least Food & Drug Administration (FDA) clearance for 510(k) Premarket Notification. The FDA has determined these Class II devices are substantially equivalent (SE) to legally marketed predicate devices, in terms of safety and effectiveness, and may be marketed in the U.S. Manufacturers must adhere to FDA regulations on labeling, manufacturing practices, and post-market surveillance. The FDA monitors adverse event reports and can mandate recalls. Manufacturer’s Instructions for Use (MIFU) must be followed.
   
5. Barrier membranes and associated grafting materials used in GTR are regulated by the FDA’s Center for Devices and Radiological Health (CDRH). Materials, such as collagen (resorbable) or Polytetrafluoroethylene (PTFE, non-resorbable), must comply with FDA standards for biocompatibility, safety, and efficacy under functional loads, per ISO-10993 standards.
   
6. To search for devices that have received FDA 510(k) clearance or Premarket Approval (PMA), please visit the FDA Devices database.

4. American Dental Association Current Dental Terminology Coding Information
5. The following CDT codes listed in this section are provided for informational purposes only. Inclusion or exclusion of a code does not constitute or imply VA coverage or provider reimbursement. The list of codes may not be all-inclusive since the American Dental Association (ADA) code updates may occur more frequently than dental CDI updates. Please refer to section II.a. in this document to review indications and clinical criteria for clinical necessity.

CDT Code	Description
D4266	Guided tissue regeneration, natural teeth – resorbable barrier, per site
D4267	Guided tissue regeneration, natural teeth – non-resorbable barrier, per site
D4286	Removal of non-resorbable barrier
D6106	Guided tissue regeneration – resorbable barrier, per implant
D6107	Guided tissue regeneration – non-resorbable barrier, per implant
D3432	Guided tissue regeneration – resorbable barrier, per site, in conjunction with periradicular surgery
D7956	Guided tissue regeneration, edentulous area – resorbable barrier, per site
D7957	Guided tissue regeneration, edentulous area – non-resorbable barrier, per site

Current Dental Terminology (CDT), Copyright ^© 2026 American Dental Association. All rights reserved.

IV. Definitions

Term	Definition
Barrier membrane	A resorbable (e.g., collagen) or non-resorbable (e.g., Polytetrafluoroethylene) material used in guided tissue regeneration to prevent epithelial migration and facilitate selective cell repopulation for bone and periodontal regeneration
Furcation defect	Bone loss in the area where tooth roots diverge, graded I–III based on severity
Guided tissue regeneration	A regenerative surgical technique using a barrier membrane to direct the growth of new bone and periodontal ligament at sites with insufficient hard or soft tissue
Intrabony defect	A periodontal defect with bone loss below the alveolar crest, classified by the number of remaining bony walls (1-, 2-, or 3-wall)
Polytetrafluoroethylene	A non-resorbable barrier membrane material used in guided tissue regeneration to promote bone and periodontal tissue regeneration

V. References

Avila-Ortiz, G., Chambrone, L., & Vignoletti, F. (2019). Effect of alveolar ridge preservation interventions following tooth extraction: A systematic review and meta-analysis. Journal of Clinical Periodontology, 46(Suppl. 21), 195–223.

Bashutski, J. D., Oh, T. J., Chan, H. L., & Wang, H. L. (2011). Guided tissue regeneration: A decision-making model. Journal of the International Academy of Periodontology, 13(2), 48–57.

Bassir, S. H., Alhareky, M., Wangsrimongkol, B., et al. (2018). Systematic review and meta-analysis of hard tissue outcomes of alveolar ridge preservation. International Journal of Oral and Maxillofacial Implants, 33(5), 979–994.

Beyene, R. T., Derryberry, S. L., Jr., & Barbul, A. (2020). The effect of comorbidities on wound healing. Surgical Clinics of North America, 100(4), 695–705.

Corbella, S., Taschieri, S., Elkabbany, A., et al. (2016). Guided tissue regeneration using a barrier membrane in endodontic surgery. Swiss Dental Journal, 126(1), 13–25.

Jonker, B. P., Roeloffs, M. W., Wolvius, E. B., & Pijpe, J. (2016). The clinical value of membranes in bone augmentation procedures in oral implantology: 
A systematic review of randomised controlled trials. European journal of oral implantology, 9(4), 335–365.

Nibali, L., Sultan, D., Arena, C., Pelekos, G., Lin, G. H., & Tonetti, M. (2021). Periodontal infrabony defects: Systematic review of healing by defect morphology following regenerative surgery. Journal of clinical periodontology, 48(1), 100–113.

Parmar, P. D., Dhamija, R., Tewari, S., Sangwan, P., Gupta, A., Duhan, J., & Mittal, S. (2019). 2D and 3D radiographic outcome assessment of the effect of guided tissue regeneration using resorbable collagen membrane in the healing of through-and-through periapical lesions – a randomized controlled trial. International endodontic journal, 52(7), 935–948.

Soldatos, N. K., Stylianou, P., Koidou, V. P., Angelov, N., Yukna, R., & Romanos, G. E. (2017). Limitations and options using resorbable versus nonresorbable membranes for successful guided bone regeneration. Quintessence international (Berlin, Germany : 1985), 48(2), 131–147.

Swami, R. K., Kolte, A. P., Bodhare, G. H., & Kolte, R. A. (2021). Bone replacement grafts with guided tissue regeneration in treatment of grade II furcation defects: a systematic review and meta-analysis. Clinical oral investigations, 25(3), 807–821.

Troiano, G., Zhurakivska, K., Lo Muzio, L., Laino, L., Cicciù, M., & Lo Russo, L. (2018). Combination of bone graft and resorbable membrane for alveolar ridge preservation: A systematic review, meta-analysis, and trial sequential analysis. Journal of periodontology, 89(1), 46–57.

Trobos, M., Juhlin, A., Shah, F. A., Hoffman, M., Sahlin, H., & Dahlin, C. (2018). In vitro evaluation of barrier function against oral bacteria of dense and expanded polytetrafluoroethylene (PTFE) membranes for guided bone regeneration. Clinical implant dentistry and related research, 20(5), 738–748.

Tsesis, I., Rosen, E., Tamse, A., Taschieri, S., & Del Fabbro, M. (2011). Effect of guided tissue regeneration on the outcome of surgical endodontic treatment: a systematic review and meta-analysis. Journal of endodontics, 37(8), 1039–1045.

UnitedHealthcare. (2026, May 1). Dental barrier membrane guided tissue regeneration (Policy No. DCP045.10) [PDF]. UnitedHealthcare.

U.S. Food and Drug Administration. (2005, April 28). Dental Bone Grafting Material Devices – Class II Special Controls Guidance for Industry and FDA Staff. U.S. Food and Drug Administration.

VI. Dental CDI History/Revision Information

Date	Summary of Update(s)
07/01/2026	New dental CDI created describing clinically necessary and not clinically necessary indications

---