What Is A Membrane? Do I Need One For My Implant Bone Graft? My Membrane Fell Out/Sticking Out And Exposed

membrane ramsey amin dds

socket membrane Ramsey Amin DDS membrane space membrane ramsey amin dds What is a membrane?  Do I need one for my dental implant bone graft?  My membrane fell out or is sticking out and exposed.

These are questions and comments I receive constantly on my blog and from patients that come to see me in Burbank, California.

Let’s review what a membrane is and its purpose.

A membrane is a barrier.  Its purpose is to prevent gum from growing into the bone cavity.  On many bone grafts for dental implants, a membrane is placed over the bone but under the gum.  There are many different types and styles of membranes but they break down into basically 2 categories.

  1. Dissolvable (resorbable) membranesBurbank Dental Implants membrane
  2. Non-dissolvable (non-resorbable) membranes

Both resorbable and non-resorbable membranes have their use.  A resorbable membrane will dissolve on its own. Non-resorbable membranes typically need to be removed at some stage during your bone graft/dental implant procedure.
collagen membrane

Resorbable membranes:

Most resorbable membranes used, as of 2014, are made of collagen.  Collagen is a protein which you may have heard of in products such as shampoos and conditioners.  It is heavily cross-linked and makes an excellent barrier.  Most commercially available collagen membranes are 15 x 20mm in dimension and look like a flat, white piece of cardboard.

They are trimmed with surgical scissors by a dental implant specialist and typically covered over bone.  Most collagen membranes are made from bovine Achilles tendon or porcine origin, which basically translates into cow and pig.  Some resorbable membranes dissolve very quickly in just days; these are typically called plugs, while other resorbable membranes can last approximately 4 months.  Most resorbable membranes are not tacked in place with titanium fixation tacks.  Some are even pericardium from heart tissue.

The other types of natural resorbable membrane would be one made from your own blood!  Platelet rich fibrin or also known as PRF, can be used to make membranes from your own platelets.  Basically 1-6 test tubes of blood is drawn at the time that I start your IV.  Those test tubes are spun in a machine called a centrifuge, which separates out the layers of your blood.  It also concentrates your blood to be used for other platelet rich preparations called PRP and PDGF.

PRF can be used as a resorbable membrane as it tends to last 7-14 days.  It is stretched out and made thin so that it can be sutured.  It becomes a durable, kind of slimy consistency which can protect a bone graft.  PRF membranes can be used in addition to resorbable or non-dissolvable membranes for dental implant bone grafting.  PRP/PRF can speed up your healing and reduce pain and complications.

There are also synthetic membranes that dissolve, such as Vicryl, which are not as commonly used.

Non-resorbable membranes:

Most non-resorbable membranes can be made of titanium and dPTFE (Dense polytetrafluoroethylene).  They are materials that form a barrier that cannot be dissolved by your saliva.  Some non-resorbable membranes, such as PTFE, are often combined with bone tacks in order to hold the membrane stable and cover the grafted bone.

One benefit of a non-dissolvable membrane– they are very predictable in generating bone.  The main downside– it has to be removed at a second procedure.  Sometimes that second procedure may involve just plucking out the membrane off the top of your socket graft or it may be more involved, such as completely reopening the gum, removing the bone tacks, and then removing the membrane.  Typically when membrane removal involves removing tacks, the dental implants are placed at the same time that the membrane is removed.

PTFE has been used for over 30 years in cardiovascular applications such as suture, vascular grafts, and heart valves. PTFE is bioinert and does not cause inflammation.

Titanium reinforced membranes, or titanium mesh, is best at holding a space.  It works like a tent and prevents collapsing of your gums to build new volume and mass underneath.

Sometimes the membrane on a socket graft will be removed after 1-4 weeks or may even fall out if it is a dPTFE style membrane.  This is okay, generally.  The purpose was to allow your gum to grow underneath it and cover over the bone graft as the membrane protects it.  Once the membrane falls out or is removed from a socket bone graft, the bone still needs to heal for usually another 3-6 months before dental implant placement.

Is it okay that my membrane showing??  It depends!!  If the intention of your membrane was to be exposed from the beginning, then it is okay that it is exposed right now.  If it was the intention for your gum to remain covering over the membrane for 4 -9 months, then you are likely having a minor complication called a dehiscence where the gum becomes exposed and naturally exposes the membrane and bone graft.  The more critical the bone graft is, the more critical it is that the tissue remained closed and the membrane is not exposed at any time.  Critical bone grafts would be onlay block bone graft, lateral window sinus bone grafts, nerve repositioning, and advanced guided bone regeneration (GBR).

A standard socket bone graft (where an outer wall is not missing) would not be considered a critical bone graft; so leaving a membrane exposed is okay.  If an outer wall is missing, this would be considered a critical size defect.

It is important to maintain proper follow-up with your dentist throughout the procedure.  It is likely that you will be on an antibiotic, such as amoxicillin or clindamycin, and a mouth rinse called chlorhexidine gluconate.

Keep in mind there are literally hundreds, even thousands of different membrane manufacturers each claiming to be better than one another.  Yes, there are better manufacturers than others, but ultimately the surgical technique, training, judgment, and expertise of your dental implant specialist is going to be the most critical factor in the success of your bone graft…choose wisely!!!!!!

You can use all of the best materials in the world, including growth factors such as  PRP/PRF/PDGF/BMP, but in the hands of an inexperienced surgeon, results may not be that good.  Of course your ability to heal is of paramount importance.  Smoking never helps.  Alcohol does not help either… Both of these slow down the healing of bone and greatly increase your chance of complications.

Wearing a removable, temporary “flipper” over a bone graft is to be done with extreme caution.  Pressure from a removable temporary will cause the bone graft and membrane to move and almost always results in failure.  Be sure you and your dentist speak about the use of a temporary and how to create space underneath it so there is no chance that it can apply pressure to the bone graft.  Some bone graft membrane reconstructions are so critical and so large that the temporary cannot be worn at all, but that is the exception rather than the rule.

Ramsey A. Amin, D.D.S. (http://www.burbankdentalimplants.com)
Diplomate of the American Board of Oral Implantology /Implant Dentistry
Fellow-American Academy of Implant Dentistry


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31 thoughts on “What Is A Membrane? Do I Need One For My Implant Bone Graft? My Membrane Fell Out/Sticking Out And Exposed

  1. Carrie S.

    Tooth #18 which had a root canal and crown done less than 5 years ago failed and shows infection which is probably into the bone or very near being i saw that little pimple for drainage out the side of the gums a few weeks ago, well it needs to be extracted.
    Whether it needs bone grafting or not , i don’t know, im trying to just trust the dentist knows best, but when insurance wont even cover a procedure other than extraction it makes me wonder if it is critical and or necessary otherwise why do it.
    I do not foresee getting an implant anytime in the near future, if ever at all (unless by odd chance winning the big lottery jackpot lol one day)

    Anyhow, im really annoyed that i wasnt able or rather even allowed to have a talk with the female oral surgeon about the procedure first. Not until i first pay the 500 dollars out of pocket for the bone graft.
    Im hoping i will at least be allowed to get her name when i call the office tomorrow and if not, well i will have to go elsewhere, but unfortunately they cant help you with this kind of problem at the local ER at a hospital.
    Which only goes to help show how easy it is to extort money out of someone in my predicament

    1. RamseyAminDDS Post author

      Sorry for your bad experience. Dental insurance has not changed in more than 40 years. It does almost nothing. It covers the most minimal and basic treatment such as cleanings and exams.

  2. Tavia

    I has a tooth extraction and bone graft to preserve the area done about 3 days ago. After only 2 days the stiches became very loose and came out. I’m now at day 4 and a very large portion of the membrane is showing. It seems to still be some inside of the gum as it is not “falling out” and I can’t see a “hole” in my gum but it’s very concerning because I am not worried about complications. Should I go back to my dentist to examine this or will it be fine? Thanks for any help.

  3. Kundan

    Hello Dr Amin,

    First of all, thank you for doing this. I had a bridge between tooth 7 and 10 that came off after 24 years. I had tooth 8 and 9 removed back in 1989 but tooth 7 and 10 have had root canal and are only partially visible.

    One doctor told me he can put a new bridge by pushing the gums and exposing teeth 7 and 10 little more. Other Doctor have said that there is no way a bridge will stay there, so he wants to extract those and put implants. He also said that there is not enough none density, so he will have to do bone graft. So far so good. He did CAT scan last week and now he is saying that he will have to insert a membrane that’s going to swell the gums, so he can add more bone graft. Does this make sense? Should I go with a bridge on existing teeth? I am 56 years old and in good health.

    Thanks for your time. I live in Chicago area. Can I call you for any advice?

    1. RamseyAminDDS Post author

      natural teeth in the front of the mouth support Bridges very well as long as both anchor teeth don’t have root canals. Your situation needs to be evaluated in person to see which option is most viable. Sometimes extending the bridge from tooth #6 to tooth #11 and avoiding all implants is sometimes the best answer while other times grafting some bone and using a membrane can create a more predictable and long-term solution.

  4. Shanita Brown

    My 15 yr old had her wisdom teeth removed. Several weeks later she complained of mouth pain. Her regular dentist took xrays and foreign objects in her gums/mouth. Tacts are what we found out they were. The oral surgeon said said a tooth dislodged and the facts hold the membrane. Is that normal?? Bcuz now he’s asking us to pay to have them removed when I didn’t even know they were their to begin with. Please help.

      1. Shanita Brown

        I’m not sure and I was never told about it during or after her procedure. She now has to have them removed because they are bothering her. Do u know why a bone graph would’ve been done??

  5. Jodi

    I had a extraction on tooth #19 and bone graft placed for me to have a implant in a few months, my concern is what was left of the “plug” it membrane just tell out. It has only been 3 days since I had the extraction, is there a chance of a dry socket happening now? Are there any other concerns I should be prepared for?

    1. RamseyAminDDS Post author

      Dry socket typically does not happen on tooth 19. The main concern is that you may or may not lose bone volume and density from the graft since the membrane was lost early. This is how dependent on technique and materials used.

  6. Suzi

    I had a bottom molar extracted and bone graft three weeks ago. Rather that the hole closing over, it has gotten bigger. I went back to the surgeon and saw a nurse who said I have lost some of the graft. I am concerned that the hole is getting bigger, so big I lost a tic tac into the hole! They have looked at it again and now I have been given a syringe to irrigate it myself which is a relief. They say they will re X ray in a few months to see if there has been enough bone graft left to take.If not they will go back in and do a second graft. Why can’t they re do the bone graft now while it is wide open? And why is it not closing over?

    1. RamseyAminDDS Post author

      There are times where secondary bone graft is needed and is often suggested. This can definitely be done at the time of implant placement and may in fact be the best time.

      In my own practice if this is something that is unforeseen, the patient is not charged a second time.

      Very Respectfully,

      Ramsey A. Amin, D.D.S.
      Diplomate of the American Board of Oral Implantology /Implant Dentistry
      Fellow-American Academy of Implant Dentistry

  7. DMC

    I am getting ready to go through this. I am a bit afraid and confused by the various methods and terminology. Thank you for your dedication and for taking the time to provide this very valuable information. I now have a better idea of the questions that need to be asked and a realistic interpretation of what needs to be done and how long it will take. Thank you … thank you!

  8. John R Bull

    I had bone augmentation surgery done in the upper back jaw some 7 weeks ago. It was to provide bone sufficient to take one or two implants in around 8 months time.
    Graft material, I’m not sure what, in the form of white granules was packed into the cavity drilled into the existing bone, and a dissolvable (resorbable) membrane placed over the top. However, I have been in pain ever since! It seems some of the small white particles have found their way past the membrane, and my dentist says it’s these that are causing the pain. I’m not convinced that the dull toothache type pain I’m experiencing is due to this.. He has removed some of these loose particles over the last few weeks, but I still have a dull almost constant dull pain in the area.
    Please can you suggest what can now be done?
    Thank you

    1. RamseyAminDDS Post author

      Something else may be going on. I would suggest another X-ray. Be sure that another nearby tooth isn’t causing all this pain. It is possible that the graft isn’t taking also. Pain should be zero at 7 weeks.

      Graft particles would not do this. Was this a socket graft or sinus lift??

      :-). RA.

      1. John R Bull

        Thank you.
        I myself was convinced it was not the particles that were causing me the pain.
        It wasn’t a sinus lift, but I assume what you call a socket graft i.e. a cavity was formed in the bone by drilling into it, and filled with the material. I have now had a 2D x-ray done yesterday, which shows a dark area next to the surgery site, which my dentist thinks is an infection. It’s being treated now with an anti biotic.
        The surgery site is right next to a recent implant/crown, completed a few days after the bone surgery, this implant feels ‘numb’, This implant is very close to the ‘dark’ area shown on the x-ray, I am not sure if this is relevant or indeed normal.
        Thank you again.

      2. John Bull

        Update on my problem:
        My dentist (who conformed he carried out an external sinus lift graft, not a socket graft), has opened up the area in question and inspected the small dark area shown on the ex-ray that I mentioned in my original note. This area is right next to the graft but not part of it. He found no infection. I have also just completed a course of anti-biotics (known here in Spain as Rhodogil), I have also had a course of penicillin (known here in Spain as Amoxicillin), taken around 5 weeks ago. They had no effect of my problem of an almost constant dull pain in that area..
        My dentist is reluctant to remove the graft, as he says he can see nothing wrong with it on the x-ray.
        If I have an infection of the graft would it show up on an x-ray of any type?
        The bone graft was carried out 2 months ago now. If I have it removed, is it now important to get it done ASAP? BTW The dentist says the membrane has started to dissolve, .
        Is it an easy process to remove the graft, knowing that it was done 2 months ago?
        Thank you.

        1. RamseyAminDDS Post author

          I reply to you in another post but if the graft is doing well it has already begun healing and may become more difficult to remove because it is fusing to your own natural bone. If it is infected, it will come out very easily. Make certain you’re sedated for this procedure if you have to remove a sinus graft. It can be extremely painful should this occur. I have not had an infected sinus and probably 10 years and I do this procedure multiple times a week. I hope you’re healthy and do not have any medical problems or smoke

      3. John R Bull

        Update on my problem:

        I still have an almost continual dull pain in the area of the graft.

        My dentist confirmed he carried out an external sinus lift graft. On a 2D x ray he noticed a small dark area just next to the bone graft. He has now opened up this area and found no sign of infection. He still thinks that I probably have an infection and prescribed a course of anti-biotics (known here in Spain as Rhodogil), I have also had a course of penicillin (known here in Spain as Amoxicillin), taken around 5 weeks ago. Neither has had effect on my problem. He is now going to refer me to a ENT specialist for advice on what other anti-biotic to use.

        He thinks the numb feeling I am experiencing in the implant/crown adjacent to the bone graft is due to the infection he thinks is there.

        I now ant him to remove the bone graft, which he is reluctant to do because he says its healing OK. But agrees that somewhere in that area he thinks its infected!

        The bone graft was carried out 2 months ago now. Is it still possible to have it removed easily and what are the risks? Is it now important to get it done ASAP, or can I afford to wait another 2 weeks say, to get a ENT specialist opinion? BTW The dentist says the membrane has started to dissolve.

        1. RamseyAminDDS Post author

          a 3-D x-ray is necessary and generally speaking I would suggest a combination of amoxicillin and metronidazole taken simultaneously for 10 days. I believe the medication you mentioned is metronidazole. 500 mg each if there are not any contraindications. metronidazole needs to be taken with another antibiotic at the same time 4 to be effective. 2-dimensional x-rays at this point is not sufficient. Numbness can occur in this area from the surgical flap. Typically there treated with steroids at the time of surgery and sometimes afterwards. The numbness is not typically from an infection in the upper jaw but sometimes this phenomenon happens in the lower jaw. Of course I have never seen you before so this is not actual medical advice… I hope it helps you. Keep me posted. ENT may prescribe you a very strong antibiotic, Levaquin

  9. jerry mader

    I had tonsil cancer 10 years ago (RADIATION AND CHEMO)
    The last two years I have lost two teeth left side far back of mouth. I cannot have an implant no bone in upper back left
    I need to have 3 teeth extracted upper right back the bone deterioration gone. I just had a bridge done there 6 months ago that has been destroyed
    what are my options ?
    I have seen different people my bottom teeth are solid my top and bottom teeth between my lips from nose to chin are solid
    should I have all my teeth pulled on top and do dentures ?
    I would love to do implants but im told i do not have enough bone this is not an option I have been told this will not last by 2 different professionals
    i have an implant in front tooth number 8 for 15 years and looks great
    Very concerned on what I should do
    from Athens GA

    1. RamseyAminDDS Post author

      Merry Christmas,

      First off make sure the radiation did not hit your upper and lower jaw. This can be confirmed with a port film from your radiation record. Radiated bone can be very slow to heal and a condition called osteonecrosis of the jaw can occur from surgery done in that area of heavy radiation.

      Bone can be easily rebuilt. I suggest you go for a third opinion.

      The upper left back bone is extremely simple to rebuild usually with a sinus lift bone graft. If needed, block grafts were bone expansion can be done to gain enough bone for dental implants. I have rarely seen a case in the last 15 years that truly nothing was possible. Oftentimes, extensive grafting can become cost prohibitive depending on each person.

      Should you decide to remove all of your teeth, computer guided surgery can help the dentist utilize your existing areas of excellent bone and avoid the areas that do not have enough bone. I commonly, extract all teeth and replace them with a Prettau dental implant bridge. Most of the time, the bone does not need to be grafted because of the unique position of the implants placed slightly deeper and closer to the tongue. Most people have good bone in this area.

      Each situation is so unique that there is no way I could answer what is best for you. I wish you lived to closer


      Ramsey Amin DDS

  10. marc andré duguay

    this article was really helpful as i had my tooth number 8 removed for implant , and then cover with a PRF so now i’m more informed.

  11. James

    I need to have # 4 extracted which is supporting a bridge. I have been told it needs to be extracted because it has a cavity under the crown that has affected the bone slightly as per x rays and destroyed the tooth under the crown. One option offered is to extract it w/o removing the 5 tooth bridge and leaving the bridge with only two supports on my own teeth #’s 2 & 6 and two pontics in 5 & 3. If I send you a copy of the #4 x ray and an Icat 3D cone beam xray of my mouth can you suggest other options? I’m looking for the MINIMUM invasive solution since although I’m in excellent health I’m in my seventies. I was thinking of replacing the extracted #4 with an implant at same time and then replacing the bridge but have been told its not wise to have a bridge between natural teeth and implants although some dentist do it and now you can get bridges made with no metal just porcelain which are strong and more FLEXIBLE like Bicon’s Trinia. Another idea is implants on 5 & 3 and a 3 position bridge between them with 4 as a pontic. The problem seems to be there is a need to do a lift for 5 which I don’t want to do. I see 5 mm of bone here based on the 3D xray and thought possibly a 5 mm bicon would work here or a soft tissue level implant to avoid the lift and just have a common implant w/o additional complications.
    Your aseptic procedure its superb. Congratulations! You are a cutting edge Dentist and a pioneer in this very special process of implantology that many think anyone can do.
    Looking forward to your response.

    1. RamseyAminDDS Post author

      Thank you for your very kind words James

      The upper jaw has very soft bone due to a high prevalence of bone marrow. The upper back teeth undergo a tremendous amount of force. It is a recipe for disaster with high bite force in soft bone.

      Placing a 5 mm long implant in the upper jawbone Is not recommended. It will fail miserably very quickly. The upper Jaw needs implants that are longer. 5 mm is a good diameter but not a good length.

      A sinus lift bone graft is truly an extremely predictable procedure done since the mid-1970s. It is highly dependent on the skill of the surgeon.

      Without seeing you in person I cannot tell you what exactly to do but I would not do any flexible type of bridges. Deafly do not connected natural tooth to an implant either.

      Even though you are 70 years old, do it right. If not you will only be removing all of this and wasting a bunch of money.

      Good luck my friend

  12. Kari

    Hello. I had surgical extraction of #9 with a bone graft consisting of cadaver bone, my own bone, and a membrane. Granuals were used. This procedure was 5 days ago. Yesterday, my stitches started coming out. Now, I only have 1. Today, on 2 separate occasions, I have had 1 granual come out onto my tongue. After the first 1 came out and I realized what it was, I panicked and grabbed a pen light to take a peek. Where I had my extraction and implant is open and I believe I see the membrane. The tissue looks good and healthy and I don’t believe I have an infection. It looks remarkably healed, actually, for day 5. Should that area be closed? I’m afraid to mess anything up if that should be closed or still stitched shut. I suffered bone loss as a result of multiple infections around #9. If I’m not mistaken, my bone loss was the outer portion of my socket. Do I have a reason to freak out? Thanks in advance!

    1. Kari

      I misspoke. Where I had my extraction and GRAFT is open and I believe I see the membrane. Sorry for my error. Also, I guess technically, it is day 6, but I haven’t been to sleep yet, so it doesn’t count! Lol

      1. RamseyAminDDS Post author

        No need to panic just yet. 😉
        Some membranes are placed in a way to purposely remain exposed while some absolutely need to be buried under the gum.
        Here is another post that may help you answer some questions
        Ramsey Amin DDS