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Larger GBR and bone grafting techniques often utilize biologic membranes placed deeper under full thickness flaps. Securing these membranes is often accomplished by bone fixation screws or tacks at the apical border of the membrane. Traditional horizontal mattress sutures can help secure membranes with their sutures crossing under the wound margin, but due to their relative coronal positioning they are not enough to secure a membrane to the alveolar plates alone. Subperiosteal suturing allows more apical control of membranes either in conjunction with screws and tacks or in lieu of other fixation methods. By engaging the periosteal membrane deep to the membrane the subperiosteal mattress technique allows for a suture to secure a membrane along its entire length rather than only at the crestal portion. If a periosteal releasing incision is utilized in a surgery the subperiosteal suture should bite the attached periosteum more apical than the releasing incision. The first bite for the subperiosteal mattress is a single throw through the attached periosteum at the flap’s deepest part. The second throw straps over the buccal plate and crest and exits from the inside to outside of the lingual flap, as deep as possible. The third and final bite is back through the lingual flap, and the suture is tied to the original tail and the knot is buried underneath the flap margins with further suturing. If a non-absorbable suture is required the first bite should be through the lingual tissue, then the periosteum, and finally back out the lingual tissue. This will allow the knot to be exposed on the lingual so it can be retrieved and removed.