Abstract Aim To compare healing responses to periosteal sliding grafts and polyglactin 910 periodontal mesh used as guided tissue regeneration (GTR) materials/techniques when both periapical and periradicular bone loss are present. Methodology Thirty patients with suppurative chronic apical periodontitis with apicomarginal communication were selected and allocated randomly into two groups according to the barrier technique to be used during periradicular surgery: periosteal graft group ( n = 15) and bioabsorbable membrane group ( n = 15). Clinical and radiological evaluations were completed prior to surgery, a week later and every 3 months after surgery up to 12 months to measure the periodontal pocket depth (PD), clinical attachment level (CAL), gingival margin position (GMP), size of periapical lesion, percentage reduction of the periapical rarefaction, and periapical healing. Results Both groups showed highly significant ( P < 0.001) reductions in periodontal PD, CAL and size of periapical lesion at 12 months whilst GMP was unaltered. No significant difference between the experimental groups was evident for these parameters, or for the percentage reduction of size of the periapical lesion and clinical‐radiographic healing. Conclusion Guided tissue regeneration applied to apicomarginal defects using sliding periosteal grafts and use of bioabsorbable membranes led to similar enhancements of the clinical outcome of periradicular surgery in terms of periapical healing, gain of periodontal support, PD reduction and minimal recession of the gingival margin.