What D4267 means

D4267 covers guided tissue regeneration, non-resorbable barrier, per site (includes membrane removal). "D" is dental, "42" is the surgical periodontal group, and "67" is this non-resorbable-membrane GTR. Like the resorbable version (D4266), it uses a barrier membrane over a periodontal (or peri-implant) defect to guide regeneration — blocking fast-growing gum tissue so slower-growing bone and ligament can regenerate the lost support. The difference is the membrane material: a 'non-resorbable' membrane doesn't dissolve, so it remains in place doing its job and must be surgically removed in a later procedure (the removal is included in this code).

Non-resorbable membranes (such as those made of materials like PTFE, sometimes titanium-reinforced) can maintain the regenerative space very reliably and hold their shape well, which can be advantageous for larger defects, defects needing robust space maintenance, or certain demanding regenerative situations. The trade-off is the need for a second procedure to remove the membrane after it has served its purpose (typically a few weeks to months later).

Like the resorbable version, it's used with bone grafts (billed separately) and doesn't include the flap surgery or graft. It can be used for periodontal and peri-implant defects. Coverage is under periodontal benefits with documentation. The choice between resorbable and non-resorbable depends on the specific case.

When it's typically used

D4267 is reported when a non-resorbable (non-dissolving) barrier membrane is placed over a treated periodontal (or peri-implant) defect to guide tissue regeneration — chosen for its reliable space maintenance in demanding defects — with the membrane later surgically removed (included in the code).

How much does D4267 cost?

A non-resorbable GTR membrane is a moderate fee, often roughly 400 to 900 USD per site depending on region — billed separately from the bone graft and flap surgery. It includes the later membrane removal. It may cost somewhat more than a resorbable membrane overall, reflecting the removal procedure and the membrane's properties.

Is D4267 covered by insurance?

Covered under periodontal benefits when documented as part of regenerative treatment for a periodontal or peri-implant defect, with the diagnosis and defect type. It's billed separately ('per site') from the bone graft and flap surgery, and the membrane removal is included in this code. Documentation of why a non-resorbable membrane was necessary supports the claim. Regenerative procedure coverage varies by plan.

When a non-resorbable membrane is chosen

Non-resorbable membranes are chosen for specific situations over resorbable ones, and understanding when clarifies their role.

The main advantage of a non-resorbable membrane is reliable, sustained space maintenance. Because it doesn't dissolve, it maintains its barrier function and its shape consistently throughout the critical healing period, without the gradual breakdown that resorbable membranes undergo. This robust, predictable space maintenance can be advantageous for certain demanding regenerative situations: larger defects that need a stable barrier maintained over the space for a longer or more reliable period; defects where maintaining the space and shape is challenging (some non-resorbable membranes are titanium-reinforced to hold their shape rigidly, creating and maintaining a defined space for regeneration); and cases where the clinician wants the certainty that the barrier will remain fully intact and functional throughout healing. In these situations, the non-resorbable membrane's reliability can improve the regenerative outcome.

The trade-off is that a non-resorbable membrane must be surgically removed in a second procedure after it has done its job (the removal is included in the D4267 code). This means an additional minor surgery, which is the main drawback compared with resorbable membranes that dissolve on their own. So the choice for a non-resorbable membrane involves accepting the removal procedure in exchange for the superior, sustained space maintenance it provides. The periodontist weighs the defect's characteristics and the regenerative demands to decide whether the non-resorbable membrane's advantages justify the removal procedure, or whether a resorbable membrane (more convenient, no removal) would suffice. Understanding that non-resorbable membranes are chosen for their reliable space maintenance in demanding cases — accepting the removal surgery for that benefit — clarifies when and why this membrane type is used over the resorbable alternative.

The membrane removal procedure

A defining feature of non-resorbable membranes is that they require removal, and understanding this second procedure clarifies what's involved.

Because a non-resorbable membrane doesn't dissolve, after it has served its purpose of guiding the regeneration during the healing period (typically a few weeks to a few months), it must be removed in a second surgical procedure. This removal is included in the D4267 code (so it's not a separate charge). The removal is generally a minor procedure: under local anesthesia, the periodontist accesses the membrane (reflecting the gum over it) and removes it, then closes the area. By this point, the regeneration beneath the membrane has progressed, and removing the membrane allows the healing to complete with the regenerated tissue in place. The removal is less involved than the original placement and recovery is usually straightforward.

This need for a removal procedure is the main practical difference from resorbable membranes (which dissolve and need no removal). For patients, it means that with a non-resorbable membrane, there will be a follow-up surgery to remove it some weeks or months after the original regenerative procedure — something to plan for. The timing of the removal is determined by the clinician based on the healing. While the extra procedure is a drawback, it's the trade-off for the membrane's superior space maintenance during the critical regenerative phase. Understanding that the membrane removal is a planned, included part of the non-resorbable GTR process — a minor second surgery after the regeneration has progressed — helps patients know what to expect with this membrane type. The periodontist explains the timeline and the removal procedure as part of planning the regenerative treatment, so patients are prepared for both the initial procedure and the later removal.

How GTR fits into regenerative periodontal treatment

Guided tissue regeneration (with either membrane type) is one component of regenerative periodontal treatment, and understanding how it fits clarifies the overall approach.

Regenerative periodontal treatment aims to rebuild the bone and attachment lost to gum disease around teeth (or implants), in defects amenable to regeneration. It typically combines several elements: flap surgery to access and thoroughly clean the defect and root surface (removing the infection and deposits), a bone graft to fill the defect and scaffold new bone, and a GTR membrane (resorbable D4266 or non-resorbable D4267) to guide the regeneration by keeping gum tissue out. Sometimes biologic materials (growth factors or proteins that stimulate regeneration) are also used. These elements work together to maximize the regeneration of the lost periodontal structures. Each is coded and may be billed separately, reflecting the distinct components and materials.

The GTR membrane's role within this is the barrier function — ensuring the bone and ligament, not gum tissue, regenerate in the protected space. It's used in suitable defects (those amenable to regeneration based on their shape) as part of the comprehensive regenerative procedure. The choice of membrane (resorbable vs non-resorbable) is one decision within planning the regenerative treatment. And as with all periodontal regeneration, the success depends on controlling the underlying gum disease first and maintaining the results with diligent ongoing care afterward — the regeneration won't last if the disease recurs. Understanding that GTR is one part of a multi-component regenerative strategy (flap, graft, membrane, sometimes biologics), used in the context of overall periodontal disease control and maintenance, helps patients grasp how the membrane fits into the broader effort to regenerate lost support and save teeth. The periodontist integrates these components into a treatment tailored to the specific defects and the patient's periodontal condition.

Realistic expectations for periodontal regeneration

Periodontal regeneration with grafts and membranes can be valuable, but having realistic expectations is important, and understanding the factors clarifies what regeneration can achieve.

Regenerative procedures aim to rebuild some of the bone and attachment lost to gum disease, improving the affected teeth's support and prognosis. However, regeneration is not always complete or guaranteed — the amount of regeneration achieved varies depending on several factors. The defect's shape is crucial (well-contained defects with more remaining bony walls regenerate more predictably than broad, open defects). The control of the gum disease matters greatly (ongoing infection would undermine regeneration). The patient's healing, oral hygiene, and factors like smoking (which impairs healing and regeneration) all influence the outcome. So while regeneration can meaningfully improve a tooth's support in favorable cases, it may achieve partial rather than complete rebuilding, and it's applied selectively to defects likely to respond.

For patients, this means approaching regenerative treatment with realistic expectations: it's a valuable tool that can improve the prognosis of teeth undermined by bone loss, potentially saving teeth that might otherwise be lost, but it's not a guaranteed complete restoration of all lost support, and its success depends on the defect, the disease control, and good ongoing care. The periodontist assesses which defects are good candidates and discusses the realistic expected outcomes for the specific situation. Understanding that regeneration is a powerful but variable tool — most successful in favorable defects with good disease control and maintenance — helps patients have appropriate expectations and appreciate the importance of their role (good hygiene, not smoking, regular maintenance) in supporting the outcome. When applied appropriately and supported by good ongoing care, regenerative treatment with grafts and membranes can be a worthwhile part of saving teeth from periodontal disease, even if the regeneration achieved is sometimes partial. The realistic goal is improving the teeth's support and prognosis where the defects and circumstances allow.

Frequently asked questions

What is the D4267 dental code?

It's guided tissue regeneration (GTR) using a non-resorbable (non-dissolving) barrier membrane, per site — placing a membrane over a treated periodontal defect to help regenerate lost bone and tissue. It's later surgically removed (included in the code).

Why use a non-resorbable membrane instead of resorbable?

Non-resorbable membranes maintain the regenerative space very reliably and hold their shape (some are titanium-reinforced), which can be advantageous for larger or demanding defects. The trade-off is needing a second surgery to remove them.

Does the non-resorbable membrane have to be removed?

Yes — because it doesn't dissolve, it's surgically removed in a minor second procedure after it has guided the regeneration (typically weeks to months later). The removal is included in the D4267 code.

How much does a non-resorbable GTR membrane cost?

Often around 400 to 900 USD per site, billed separately from the bone graft and flap surgery. It includes the later removal procedure and may cost somewhat more than a resorbable membrane overall.

How does the membrane fit into regenerative treatment?

It's one component — regenerative treatment combines flap surgery to clean the defect, a bone graft to fill it, and a GTR membrane to guide regeneration (keeping gum tissue out), sometimes with biologics. Each is often billed separately.

Is periodontal regeneration guaranteed to work?

No — the amount of regeneration varies with the defect shape (contained defects respond better), disease control, healing, and factors like smoking. It can improve a tooth's support and prognosis but may be partial. Realistic expectations matter.

This page is an independent, plain-language explanation for general information only. It is not billing, coding, or clinical advice. For the official CDT descriptor and current-year wording, refer to the American Dental Association.