1.Activated Sludge Process (ASP): Combining MBBR with traditional activated sludge processes can enhance biological treatment capacity and efficiency. The MBBR acts as a pre-treatment step, reducing the organic load before it enters the activated sludge system, which can lead to smaller reactor sizes and reduced aeration energy requirements.

2.Membrane Bioreactors (MBR): Integrating MBBR with membrane bioreactors (MBR) combines the benefits of biofilm-based and membrane-based treatments. The MBBR can reduce the organic and nutrient load, preventing membrane fouling and extending the lifespan of the MBR system. This combination is particularly useful for applications requiring high-quality effluent.

3.Sequential Batch Reactors (SBR): MBBR systems can be used before SBR systems to enhance the removal of organic matter and reduce the load on the SBR. This can improve the overall efficiency of the SBR system and help in achieving more stable operation.

4.Advanced Oxidation Processes (AOPs): For effluents requiring further treatment to remove persistent organic pollutants, pathogens, or to achieve disinfection, MBBR systems can be followed by advanced oxidation processes. AOPs, such as ozone, UV, and hydrogen peroxide treatment, can degrade compounds that are resistant to biological treatment.

5.Sand Filtration and Ultrafiltration: To remove suspended solids, pathogens, or specific pollutants from the effluent of an MBBR system, sand filtration or ultrafiltration can be applied. These physical filtration methods can significantly improve water clarity and quality, making the water suitable for discharge or reuse.

6.Chemical Treatment: In cases where specific contaminants need to be removed or if phosphorus removal is required, chemical treatment processes like coagulation/flocculation can be used in conjunction with MBBR. This can be particularly useful in industrial applications where effluent standards are stringent.

7.Denitrification Filters: For enhanced nitrogen removal, MBBR systems designed for nitrification can be followed by denitrification filters. This is beneficial in treating wastewater with high nitrogen content, helping to meet strict discharge limits.