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Table 1 Summary of the different types of barrier-membranes used for reconstruction of bone defects

From: The role of barrier membranes for guided bone regeneration and restoration of large bone defects: current experimental and clinical evidence

Types of membranes   
Bioresorbable membranes Advantages Disadvantages
Natural membranes Collagen
(different subtypes, predominantly type-I collagen, derived from different animals, (bovine or porcine) and from different sites (tendon or dermis) [40]
- highly biocompatible (no adverse effect to surrounding tissues during degradation)
- it promotes wound healing [41]
- it allows good integration with connective tissue (fibrous encapsulation with differentiation of a periosteum-like tissue upon the external bony surface) [42, 43]
- osteoblasts and fibroblasts can attach to collagen membranes irrespective of its origin [44]
- differently cross-linked collagen membranes can promote cell attachment and proliferation [45]
- degradation in vivo is too rapid to maintain the structural integrity necessary for bone regeneration [44]
- different cross-linking techniques used to prolong degradation time (it varies from four weeks up to six months) [40, 41, 46]
- differently cross-linked collagen membranes can also inhibit cell attachment and proliferation [45]
- chemicals used for cross-linking have cytotoxic effects on the surrounding tissues leading to gap formation between the membrane and the connective tissue and facilitate microbial accumulation [43] (to address this, a non-chemical cross-linking nanofibrous collagen membrane has been developed) [47]
- variable mechanical properties among the different available membranes
- risk of peri-operative rupture
- moistening of the membrane (unavoidable in vivo) alters considerably the mechanical properties [48]
- possible disease transmission from animals to humans [21, 31]
  Chitosan or chitosan-collagen hybrid - non-toxic natural polymer (polysaccharide)
- it enhances wound healing and bone formation [49]
- it has hemostatic properties [50]
- excellent biocompatibility [51], osteogenic cells can proliferate and express osteogenic markers [51]
- chitosan-hybrid membranes have superior mechanical properties [52, 53]
- limited evidence from in vivo studies
Synthetic membranes Aliphatic polyesters: PLLA, PLGA, polydioxanone and their co-polymers [5254] - the most commonly used and studied bioabsorbable polymer
- commercially available and approved for clinical use
- by changing the composition and the manufacturing procedure, resorption time, handling properties and mechanical durability can be adjusted to suit the clinical situation [54]
- different chemical compositions did not affect on bone regeneration in vivo [55]
- slow-degrading membranes induce greater amounts of neovascularization and a thinner fibrous capsule versus fast degrading membranes [56]
- they can induce host-tissue response and foreign body reactions during degradation (by non-enzymatic hydrolysis) [13, 38, 42, 5759]
- the moderate cytotoxic reactions may reduce cellular adhesion [43]
Non-resorbable membranes   
Expanded polytetrafuoroethylene (e-PTFE)
And others: titanium reinforced ePTFE, high-density-PTFE, or titanium mesh [23]
- extensively studied [26]
- biocompatible
- they maintain their structural integrity during implantation and have superior space-maintaining properties and capacity for cell occlusion than degradable membranes
- semipermeable ePTFE is more effective than the high-density ePTFE [28]
- for large segmental bone defects, cylindrical titanium mesh cage used as a scaffold [29]
- a second surgical procedure is required for removal (additional potential risk to the newly regenerated tissues [30])
- membrane exposure is frequent, increasing the risk of secondary infection [31, 32]
- e-PTFE can induce slight to moderate cytotoxic reactions and reduce cellular adhesion
Novel membranes   
Alginate membrane - close assimilation to bone surface
- no inflammatory response [60]
- easy handling with an alginate base self-setting barrier membrane versus a ready-made membrane [61]
-more efficacious versus collagen membranes for mandibular and tibial defects [62, 63]
- limited evidence from in vivo studies
Others [6468]:
- degradable biopolymer poly (lactide-co-ε-caprolactone)(PLCL),
- a nano-hydroxyapatite/polyamide(nHA/PA66) composite
- an in situ-formed polyethylene-glycol-hydrogel membrane
- amniotic membranes
- a bacterially-derived polymer
- a hybrid membrane consisting of layers of collagen containing hydroxyapatite (HA) and chitosan [69]
- polyethersulfone (PES) electrospun nanofibrous membranes [70]
- a biomimetic tubular calcium phosphate (CaP)-coated nanofiber mesh combined with platelet rich plasma-mediated delivery of BMP-7 [71]
- Latex [72]
- membranes with additional anti-bacterial properties or antimicrobial coating [7375]
- optimized properties for GBR
- improved three-dimensional structure and osteogenic bioactivity
- they can be loaded with cells to mimic natural bone
- no foreign body inflammatory reaction or rejection and satisfactory bone formation
- membranes with additional anti-bacterial properties or antimicrobial coating may reduce membrane-associated infections
  1. BMP, bone morphogenetic protein;GBR, guided bone regeneration; PLGA, poly(L-lactide-co-glycolide); PLLA, poly(L-lactide).