técnica de regeneración Ósea

7/26/2019 Tcnica de Regeneracin sea

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Tcnica de Regeneracin sea. Plasma rico en plaquetas

Categora: Implantes Dentales

Por Roberto acua

TRAS UNA LESIN, INCLUIDAS LA EXTRACCIN DE UN DIENTE O LA INSERCIN DE UN

IMPLANTE, EL HUESO PUEDE RECONSTRUIRSE POR MEDIO DE PROCESOS

FISIOLGICOS DE REMODELACIN O CICATRIZACIN.

Regeneracin ea

Tra !na "ein, inc"!i#a "a e$%raccin #e !n #ien%e & "a inercin #e !n i'("an%e, e" )!e& (!e#e

rec&n%r!ire (&r 'e#i& #e (r&ce& *ii&"gic& #e re'e"acin & cica%ri+acin. En e%&

(r&ce& (!e#en inc&r(&rare 'a%eria"e #e a!'en%& e& (ara *a&recer & e%i'!"ar e"

creci'ien%& #e" )!e& en +&na en "a -!e )aa #ea(areci#& c&'& c&nec!encia #e (r&ce&

(a%&"gic&, %ra!'/%ic& & *ii&"gic&. E%& !%i%!%& e& (!e#en ac%!ar &0re e" )!e&

)!1(e# (&r 'e#i& #e %re 'ecani'& #i*eren%e2 &%e&c&n#!ccin, &%e&in#!ccin 3&

&%e&g1nei.

Osteoconduccin

La &%e&c&n#!ccin carac%eri+a e" creci'ien%& e& (&r a(&icin, a (ar%ir #e" )!e& e$i%en%e (&r enci'a #e" 'i'&. P&r c&nig!ien%e, e necei%a (ara #ic)& (r&ce& "a (reencia #e )!e& &

#e c1"!"a 'een-!i'a%&a #i*erencia#a. La cica%ri+acin ea a"re#e#&r #e !n i'("an%e

&%e&in%egra#& e !n (r&ce& &%e&c&n#!c%i& ig!e "a *ae %4(ica #e re'e"acin a nie" #e

"a in%er*ae )!e&5i'("an%e.

L& 'a%eria"e &%e&c&n#!c%i& &n 0i&c&'(a%i0"e. Se (!e#en #earr&""ar %e6i#& e& & %e6i#&

0"an#& (&r a(&icin &0re e%& 'a%eria"e in -!e e (r!+can ign& #e reaccin %$ica. L&

'a%eria"e &%e&c&n#!c%i& '/ !%i"i+a#& en i'("an%&"&g4a &n (r!c%& a"&("/%ic&. L&

'a%eria"e a"&("/%ic& &n e$c"!ia'en%e (r!c%& in%1%ic& 0i&c&'(a%i0"e #earr&""a#& (ara

a%i*acer !n gran n7'er& #e in#icaci&ne. Se *a0rican en !na gran arie#a# #e %e$%!ra, %a'a8&

#e (ar%4c!"a *&r'a, -!e e (!e#en c&neg!ir */ci"'en%e.

P!e#en c"ai*icare en cer/'ica, (&"4'er& c&'(&i%e. L& '/ e'("ea#& &n "a cer/'ica,

-!e (!e#en er 0i&5iner%e 9$i#& #e a"!'ini& $i#& #e %i%ani&: & 0i&5ac%ia 9'a%eria"e #e *&*a%&

c/"cic&:. La cer/'ica 0i&5iner%e n& e !nen #irec%a'en%e c&n e" )!e& )!1(e# e 'an%ienen
http://www.odontologia-online.com/publicaciones/implantes-dentales/102-regeneracion-osea-plasma-rico-en-plaquetas.htmlhttp://www.odontologia-online.com/publicaciones/implantes-dentales.htmlhttp://www.odontologia-online.com/publicaciones/implantes-dentales/102-regeneracion-osea-plasma-rico-en-plaquetas.htmlhttp://www.odontologia-online.com/publicaciones/implantes-dentales.html


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en c&n%ac%& c&n e" 'i'& (&r 'e#i& 'ec/nic&. La cer/'ica 0i&5ac%ia &n e" (rinci(a" gr!(&

#e a"&("a%& e'("ea#& (ara e" a!'en%& e&, e inc"!en "a )i#r&$i"a(a%i%a 9HA: e" *&*a%&

%ric/"cic& 0e%a. Se )a (i#& #e'&%rar -!e e (r!ce !n c&n%ac%& -!4'ic& en%re e" )!e& e"

'a%eria" in6er%a#&.

E$i%en #& ca%eg&r4a #e 'a%eria"e &%e&c&n#!c%i& (ara e" 'an%eni'ien%& & e" a!'en%&

%i!"are2 n& rea0&r0i0"e rea0&r0i0"e.

Si e c&"&can 0a6& "a (ie" & rea#& #e %e6i#& *i0r&&, e%& 'a%eria"e n& *&r'an )!e&.

Per'anecen re"a%ia'en%e e%a0"e, & &n rea0&r0i#&. Pe'& re!'ir "a ec!encia #e"

ig!ien%e '&2

;. A!'en%& e& (&r &%e&c&n#!ccin2

a. C1"!"a #i*erencia#a 9&%e&0"a%&: -!e crecen 6!n%& a "a !(e*icie (&r a(&icin.

0. A"&("a%& 9'/ *rec!en%e:2

;.Sin%1%ic& 9cer/'ica, (&"4'er&, c&'(&i%e:.


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c&n "a !(er*icie #e "a HA. Parece er -!e "a *!en%e #e a& ang!4ne& en #earr&""& #e%er'ina

e" %e6i#& #e c&n%ac%&. E" %e6i#& *i0r&& (!e#e crecer >,? '' #iari&, 'ien%ra -!e e" )!e& (!e#e

)acer"& a !n ri%'& #e ?> !' a" #4a@ (&r c&nig!ien%e, e" re!"%a#& *a&rece a" %e6i#& *i0r&&.

C!an#& e c&"&ca HA &0re )!e& c&r%ica", e" e%ra%& in*eri&r (!e#e %ener )!e& en "a in%er*ae,(er& "a 'a&r4a #e" 'a%eria" -!e#a enca(!"a#& (&r %e6i#& *i0r&&. C!an#& "a HA e c&"&ca #en%r&

#e" )!e& (re(ara#& & en !n a"1&"& #en%a", & e c!0re c&n !na 'e'0rana #e (&r& (e-!e8&, "a

in%er*ae %i!"ar *&r'a#a !e"e er )!e&.

La HA #ena e !n 'a%eria" in&rg/nic& n& (!e#e crecer & *i6are c&n rigi#e+ &0re "a !(er*icie #e

!n i'("an%e. A#e'/, e !n (r!c%& (areci#& a "a cer/'ica, '! #!ra #i*4ci" #e c&r%ar c&n !n

c!c)i""& & !na *rea. P&r c&nig!ien%e, c!an#& e c&"&ca HA #ena en *&r'a #e (ar%4c!"a en e"

en& #e" )!e&, "& -!e e (re%en#e (&r "& genera" e &0%!rar e" )!ec&, 'an%ener e" &"!'en "a

*&r'a #e" )!e& & !%en%ar !na (r%ei re'&i0"e '!c&&(&r%a#a. Si e #eea iner%ar !n

i'("an%e en#&e& en "a regin #e )!e&5HA, (!e#e er necearia !na *rea #e #ia'an%e !n

%&rn& #e gran e"&ci#a# (ara 'i*icar "a HA.

E c&rrien%e !%i"i+ar HA #ena en (ar%4c!"a c&n i'("an%e en#&e& en "a ("aca *acia" (ara

'e6&rar "a '&r*&"&g4a #e "& %e6i#& 0"an#&. E%e 'a%eria" %a'0i1n e !a (ara a!'en%ar e"

re0&r#e (ara "a !%en%acin #e (r%ei.

E" eg!n#& %i(& #e 'a%eria" &%e&c&n#!c%i& e rea0&r0e c!an#& e c&"&ca en e" in%eri&r #e" )!e&

& "& %e6i#& 0"an#&. E%a e(ecia"'en%e in#ica#& c!an#& e" )!e& (!e#e crecer (ri'er& 6!n%& a"

'a%eria" (&%eri&r'en%e !%i%!ir"&, #e '& (areci#& a "a !%i%!cin (r&greia -!e e &0era

en "a re'e"acin #e" )!e& na%!ra".

E%& 'a%eria"e !e"en er (r!c%& #e HA a'&r*& '! (&r&& & 0ien c&'0inaci&ne #e

*&*a%& c/"cic&. C&niene e8a"ar -!e %& "& (r!c%& #e HA e rea0&r0en en (reencia #e !n

PH 0a6& 9in*eccin: c&n !na ra(i#e+ (areci#a a "a #e c!a"-!ier c&'0inacin #e *&*a%& c/"cic&. La

HA e rea0&r0e a "a ig!ien%e e"&ci#a#e2

;. E%r!c%!ra2

a. Dena, cri%a"ina2

;:Rea0&rcin '4ni'a.

0. A'&r*a2


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#e e(aci& (&r&&


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E" )!e& c&nge"a#& e &0%iene #e "& ca#/ere e a"'acena c&nge"a #irec%a'en%e. Ta'0i1n

(!e#e irra#iare (ara re#!cir "a reaccin in'!ni%aria #e" rece(%&r. E *!n#a'en%a"'en%e

&%e&c&n#!c%i& rara e+ e !%i"i+a en i'("an%&"&g4a.

Para &0%ener )!e& #e)i#ra%a#& (&r c&nge"acin, e neceari& &'e%er"& a !n (r&ce& a#ici&na"#e #eecacin. Se 'an%iene "a 'a%ri+ in&rg/nica, (er& e necei%an "& &%e&c"a%& (ara -!e

"i0eren "& *ac%&re #e creci'ien%& #e" )!e&, #e0i#& a "a a"e c/"cica *&*/%ica -!e -!e#an.

L& &%e&c"a%& (!e#en in#!cir re&rcin ea en "a regin, c&n "& -!e e" (r!c%& e 'en&

(re#eci0"e. E" )!e& #e)i#ra%a#& (&r c&nge"acin *!nci&na %a'0i1n *!n#a'en%a"'en%e (&r !n

(r&ce& &%e&c&n#!c%i&.

E" )!e& #e)i#ra%a#& (&r c&nge"acin #e'inera"i+a#& 9HDDC: %a'0i1n e &0%iene a (ar%ir #e

ca#/ere. E" (r&ce& (ara "a e"a0&racin #e" HDDC e '! e(ec4*ic&, c!a"-!ier ariacin

i'(&r%an%e (!e#e a"%erar "& re!"%a#&. Se rec&ge )!e& c&r%ica" 3& %ra0ec!"ar #e !na (er&na

c&'("e%a'en%e ana. Se "aa c&n ag!a #e%i"a#a e %ri%!ra )a%a &0%ener (ar%4c!"a #e ?5?>>

!' #e %a'a8&. E" (&"& e #e'inera"i+a c&n /ci#& c"&r)4#ric& & n4%ric& >,N #!ran%e 5; )&ra.

Una e+ #e)i#ra%a#&, e !e"e e%eri"i+ar c&n $i#& #e e%i"en& #eecar (&r c&nge"acin (ara

re#!cir a7n '/ ! an%igenici#a#. Se e*ec%7an aria (r!e0a (ara a"&rar "a eg!ri#a# #e"

(r&ce&@ e" (r&ce& #e #e'inera"i+acin c&n /ci#& #e%r!e c!a"-!ier ir! 'icr&&rgani'&

(a%gen& c&n&ci#&. Me#ian%e e" (r&ce& re#!c%&r c&n /ci#&, e e"i'inan #e" )!e& "a a"e #e

ca"ci& *&*a%&. E" )!e& -!e -!e#a #e(!1 #e e%e %ra%a'ien%& %a4a c&nera "& *ac%&re

&rg/nic& #e creci'ien%& &%e&g1nic& en "a 'a%ri+ necearia (ara "a *&r'acin ea, inc"!i#& "a

(r&%e4na '&r*&g1nica ea 9PMO:, e" *ac%&r #e creci'ien%& #e &rigen ("a-!e%ari& e" *ac%&r #e

creci'ien%& #e %ran*&r'acin. E" )!e& c&r%ica" c&n%iene "a 'a&r (ar%e #e "a PMO #e" )!e&. A"

e"i'inar "a a"e #e" )!e&, "a (r&%e4na in&"!0"e (!e#en (aar a ! en%&rn& in necei#a# #e

"a ac%ii#a# &%e&c"/%ica. De0i#& a e""&, e (&i0"e %ran*&r'ar en &%e&0"a%& '/ c1"!"a

in#i*erencia#a, e" (r&ce& #e *&r'acin #e )!e& e &%e&in#!c%i&.

Si e c&"&ca 0a6& "a (ie" !n 'a%eria" &%e&in#!c%i&, e%e er/ !%i%!i#& (&r (e-!e8a can%i#a#e

#e )!e&. P&r c&nig!ien%e, e !%i"i+a c!an#& e" en%&rn& n& *a&rece "a 4n%ei ea. Ta'0i1n e

(!e#e e'("ear c&n 'a%eria"e a!%gen& ! &%e&c&n#!c%i&, c&n "& -!e e c&nig!e *&r'ar '/

%e6i#& e& -!e in e" HDDC.

Osteognesis


6/17

La &%e&g1nei )ace re*erencia a "& 'a%eria"e -!e (!e#en *&r'ar )!e&, inc"!& in "a

(reencia #e c1"!"a 'een-!i'a%&a in#i*erencia#a "&ca"e. L& 'a%eria"e #e in6er%&

&%egen& e%/n *&r'a#& (&r c1"!"a ea ia, -!e (r!cen gran#e can%i#a#e #e *ac%&re

#e creci'ien%& (ara e" )!e&. En "a ac%!a"i#a#, e" )!e& a!%gen& e e" 7nic& 'a%eria" &%egen&

#i(&ni0"e. La +&na #&nan%e '/ !%i"i+a#a &n "& in6er%& e& a!%gen& #e cre%a i""4aca &

in6er%& e& "&ca"e #e "a %!0er&i 'a$i"ar, "a ra'a acen#en%e & "a 4n*ii 'en%&niana. E"

)!e& 'e#!"ar & %ra0ec!"ar c&n%iene "a 'a&re c&ncen%raci&ne #e &%e&ci%&. E%a c1"!"a

#e0en a"'acenare en !er& a"in& e%1ri", "ac%a%& #e Ringer & &"!cin e%1ri" #e #e$%r&a a" ?

ag!a (ara 'an%ener "a i%a"i#a# ce"!"ar. E%a c&n%rain#ica#& e" !& #e ag!a #e%i"a#a (ara e%e

c&'e%i#&, "a angre en&a n& e %an e*ica+ c&'& e" !er& a"in& & "a #e$%r&a c&n ag!a.

Da#& -!e e" 'a%eria" #e in6er%& #e0e &0%enere 'e#ian%e !na in%erencin -!ir7rgica a#ici&na", e

e'("ea c!an#& "a c&n#ici&ne (ara e" creci'ien%& #e" )!e& &n 'a"a 3& 6!n%& c&n "& &%r&'a%eria"e i e necei%a &"!'en.

E" )!e& a!%gen& %iene !na 'a%ri+ in&rg/nica, *&r'a#a *!n#a'en%a"'en%e (&r HA, -!e c&n%iene

&%e&ci%&, &%e&0"a%&, &%e&c"a%& (r&%e4na &%egena. E" )!e& 'e'0ran&& &0%eni#& #e

"a 4n*ii 'an#i0!"ar re(reen%a !na e$ce"en%e *!en%e #e )!e& a!%gen&, c&n '! 0!ena

(r&(ie#a#e, c&'& "a reac!"ari+acin (rec&+, e" gran (&%encia" #e PMO e" gran n7'er& #e

c1"!"a ia. C&n e%e '1%& e (!e#en a!'en%ar +&na re#!ci#a #e !n& a c!a%r& #ien%e.

E" 'ecani'& #e creci'ien%& e& c&n )!e& a!%gen& inc"!e "& %re '1%&.La c1"!"a ia, *!n#a'en%a"'en%e #e "a regin %ra0ec!"ar, (!e#en iir *&r'ar rea"'en%e !n

(r!c%& &%e&i#e. Sin e'0arg&, e" !'ini%r& ang!4ne& e" n7'er& #e c1"!"a in*"!en

n&%a0"e'en%e en e" re!"%a#&. E%e (r&ce& #e e*ec%& &%egen& #i'in!e a" ca0& #e

e'ana. A" rea0&r0ere e" )!e&, (!e#e "i0erar PMO &%ra (r&%e4na (ara *&r'ar )!e& (&r e"

(r&ce& &%e&in#!c%i&. E%e c&'ien+a a(r&$i'a#a'en%e a" ca0& #e e'ana e (!e#e

(r&"&ngar #!ran%e 'ee.

E" )!e& c&r%ica" e "a (rinci(a" *!en%e #e e%a (r&%e4na. Una gr!ea ca(a c&r%ica" &0re e" in6er%&

(!e#e i'(e#ir -!e e" %e6i#& *i0r&& ina#a "a +&na, ac%7a c&'& !na 'e'0rana #e (&r&

(e-!e8&, #irigien#& "a regeneracin. E" an#a'i& #e" in6er%& e& a!%gen& %a'0i1n (!e#e *&r'ar

%e6i#& e& (&r e" e*ec%& &%e&c&n#!c%i& a" ir *&r'/n#&e n!e& )!e& 'e#ian%e !%i%!cin

(r&greia. 9;: 9


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La e%i'!"acin #e "a regeneracin #e %e6i#& #e" &rgani'& )a i#& !n& #e "& re%& '/

(ereg!i#& an)e"a#& (&r "& e(ecia"i%a en aria#a /rea %era(1!%ica. En e" /'0i%& #e "a

i'("an%&"&g4a &ra", c&n "a a(aricin #e" P"a'a Ric& en ("a-!e%a e c!en%a c&n !na %1cnica -!e

(er'i%e "a regeneracin ea 'e#ian%e !na !%ancia a!%"&ga, (r&(ia #e" in#ii#!&.9B:

De#e -!e "& i'("an%e in%rae& r&ca#& %i(& %&rni""& e i'(!ier&n 'a&ri%aria'en%e a "a

#e'/ *&r'a #e i'("an%&"&g4a , e 0!c "a *&r'a #e (&%enciar ! gra#& #e a#)ein 'e#ian%e

%ra%a'ien%& !(er*icia"e, #e "a r&ca (rinci(a"'en%e. A4 %ene'& e" ree%i'ien%& #e" i'("an%e

(&r ("a'a #e %i%ani&, -!e a!'en%a "a !(er*icie #e" c!er(& #e a ece9 S%eine'ann, ;,

Te%), ;;, irc) c&". ;:. E" ree%i'ien%& #e )i#r&$ia(a%i%a, -!e en #ier& e%!#i& e

#e'&%r -!e e a&cia a 0!en& re!"%a#& (&r e(aci& #e a(r&$i'a#a'en%e ? a8&, (eri& #e

re(!e%a *a&ra0"e en !n ? 9irc), ;;@ en% c&", ;>@ ra!er, ;: 9?:

O%ra %1cnica #e %ra%a'ien%& #e "a !(er*icie #e "& i'("an%e &n %1cnica #e !%raccin, enc&n%ra(&icin a "a an%eri&re -!e &n #e a#)iin. E%a &n arena#&, gra0a#& /ci#&, %ra%a'ien%&

c&n "aer.

L& 7"%i'& a#e"an%& en i'("an%&"&g4a (ara a!'en%ar "a a#)ein i'("an%e5)!e&, e #ecir "a

&e&in%egracin, e #irigen a a!'en%ar & 'e6&rar "& 'ecani'& in%r4nec& #e re(!e%a ce"!"ar,

cen%r/n#&e en !n e"e'en%& n!e&2 "a angre ! c&'(&nen%e.9B: 9?:

De e%a 'anera e ""ega a" ("a'a ric& en ("a-!e%a 9PRP:

L& ine%iga#&re )an i#en%i*ica#& !%ancia 0i&"&gica'en%e ac%ia, -!e (r&'!een "a

re(aracin #e" %e6i#& a*ec%a#&. E%& agen%e )an i#& #en&'ina#& *ac%&re #e" creci'ien%&9 F.C:.

9;;:

E%& FC c&'(ar%en !na erie #e carac%er4%ica -!e &n c&'!ne2

5 S&n g"!c&(r&%eina -!e a*ec%an e" c&'(&r%a'ien%& ce"!"ar !ni1n#&e a rece(%&re #e 'e'0rana

("a'/%ica #e a"%a a*ini#a#.

5 Ac%7an en ! 'a&r4a en *&r'a "&ca"i+a#a (!e#en er c"ai*ica#& c&'& *ac%&re (ar/crin&

c!an#& &n (r!ci#& (&r !na c1"!"a (ara e%i'!"ar a &%ra, a!%crin& c!an#& &n (r!ci#& (&r

!na c1"!"a (ara er a!%&e%i'!"a#a en#&crin& c!an#& %ienen accin i%1'ica.

5 L& FC ,a*ec%an a ari& een%& ce"!"are, a#e'/ #e %ener ac%ii#a#e 'i%&genica, #e

#i*erenciacin #e 'igraci&n ce"!"ar.

5 E" e*ec%& #e "& FC en e" (r&ce& regenera%i&, (r&0a0"e'en%e ea !na accin c&'0ina#a, c&n

&%r& FC. 9;


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L& *ac%&re #e creci'ien%& e%/n en "a ("a-!e%a. En ee c&ncen%ra#& #e ("a-!e%a -!e n&&%r&

"e e%a'& c&"&can#& a" (acien%e en !n #e%er'ina#& "!gar, #e ea ("a-!e%a e "i0eran "&

*ac%&re #e creci'ien%& -!e e%/n #en%r& #e" ci%&("a'a, #en%r& #e "a 'i'a c1"!"a, &n "&

encarga#& #e (r!cir "a *&r'acin #e )!e& en ee "!gar. De )!e&, #e *i0ra, e #ecir, "a

(r!ccin #e c1"!"a en !n en%i#& #e%er'ina#& 9:

La ("a-!e%a & %r&'0&ci%& &n "& encarga#& #e *&r'ar *ac%&re #e creci'ien%& en "a e%a(a

inicia"e #e "a cica%ri+acin #e !na )eri#a. En !na e%a(a (&%eri&r, "& 'acr*ag& egregan

ci%&-!ina, c&'("e%an e" (r&ce&. Diera ine%igaci&ne #e'!e%ran -!e !n a!'en%& en "a

#i(&ni0i"i#a# #e "& *ac%&re #e creci'ien%& re#!ce "& %ie'(& #e cica%ri+acin 'e6&ran#& "&

re!"%a#& 9;>: 9: Ac&r%a "& %ie'(& #e e(i%e"i+acin #e "& c&"ga6& #i'in!e "a (&i0i"i#a#e

#e in*eccin 'ini'i+a "a '&"e%ia #e" (acien%e 9;:

L& *ac%&re #e creci'ien%& ("a'/%ic& &n !na (r&%e4na -!e #ee'(e8an !n (a(e" *!n#a'en%a"en "a 'igracin, #i*erenciacin (r&"i*eracin ce"!"ar. L& '/ c&n&ci#& &n2

PRGF a"*a2 *ac%&r #e creci'ien%& #eria#& #e "a ("a-!e%a, "i0era#& (&r gr/n!"& a"*a

("a-!e%ari&.

TGF5=e%a2 *ac%&r #e creci'ien%& %ran*&r'a#& %i(& 0e%a.

FGF2 *ac%&r #e creci'ien%& *i0r&0"/%ic&.

JEGF2 *ac%&r #e creci'ien%& ac!"ar en#&%e"ia".

=MP2 (r&%e4na '&r*&gen1%ica ea

IGF2 *ac%&r #e creci'ien%& #e %i(& in!"4nic& %i(& I, II

EGF2 *ac%&r #e creci'ien%& e(i#1r'ic& 9: 9B: 9: 9;


9/17

5 E" PDGF %iene aria acci&ne2

5O%e&c&n#!c%ia2 #irigien#& "a S%e' a c1"!"a &%e&(r&geni%&ra.

5Mi%gena2 a!'en%an#& "a (r&"i*eracin #e c1"!"a en re(aracin.

5Angi&gene%ica2 a!'en%an#& (&r 'i%&i c&n%in!a 0r&%e ac!"are.

5 E" TGF 0e%a ac%7a &0re2

5E" (re &%e&0"a%&, in#!ci1n#&"& a "a 'i%&genei.

5EL &%e&0"a%&, (ara -!e ecre%e 'a%ri+ &%e&i#e.

5E" &%e&c"a%& ,in)i0ien#&"&.

5E" *i0r&0"a%& ,e%i'!"an#& ! creci'ien%&, *a&recien#& "a ne&*&r'aci&n &ea.

5 Ha%a a-!4 e ig!a" "a cica%ri+acin (ara "& %e6i#& 0"an#& -!e (ara e" )!e&, (er& e%e !"%i'&

necei%a !n %e6i#& #e &(&r%e

5 C&'ien+a "a (r&"i*eracin ca(i"ar #en%r& #e" c&ag!"& ,c&n "& -!e a!'en%ar4an "& 'acr&*ag&

,(ara e" #ec&'0r& #e #e)ec)&. E%& 'acr*ag& "i0eran Fac%&re angi&gen1%ic&

'acr&*agic& 9MDAF: *ac%&r #e creci'ien%& 'acr&*agic& 9MDGF:, -!e c&n%in7an c&n "& e*ec%&

#e "& *ac%&re ("a-!e%ari& -!e &n #e i#a c&r%a.

5 En #& e'ana e re%a0"ece e" P) e" gra#ien%e #e &$igen& ,"a S%e' *&r'ar&n n!e&

n7c"e& e& a"re#e#&r #e a& * i0ra ne&*&r'a#a.

5 Se #i!e"e e" c&ag!"&, e #egra#an "& %e6i#& necr%ic& (&r 'e#i& #e "in*&ci%&, 'acr*ag&

&%e&c"a%&, -!e rea0&r0en "& re%& #e ir!%a ea "i0eran#& =MP, !n /ci#& in&"!0"e

(reen%e en "a 'a%ri+ &rg/nica, -!e c&n%in!a "a *!ncin #e &%e& c&n#!ccin -!e )a04an

c&'en+a#& "& FC. 9;;:

La accin #e ca#a !n& #e "& *ac%&re #e creci'ien%& en "& #e*ec%& e& e '7"%i("e. En

'&'en%& #i*eren%e e""& in#!cen ac%ii#a#, (r&"i*eracin, #i*erenciacin -!i'i&%/$i en

#i*eren%e c1"!"a 0"anc&, c&'& "& (!e#en er 'acr*ag& &%e&0"a%&. A#e'/ "& *ac%&re #e

creci'ien%& e%i'!"an "a angi&g1nei. La 'a&r accin #e ac%iacin #e !n Kc&c%ai"K en

c&'(aracin c&n ca#a !n& #e "& *ac%&re in#ii#!a"'en%e e #e6a er en e" e6e'("& #e "a

(r&"i*eracin in Ji%r& #e "& &%e&0"a%&. 9:


10/17

Pr&"i*eracin #e &%e&0"a%& 0a6& "a in*"!encia #e !n& & ari& *ac%&re #e creci'ien%&.

P&r 'e#i& #e "a #i(&ni0i"i#a# #e "& *ac%&re #e creci'ien%& (r&(i& #e" (acien%e e #eenca#ena

"a caca#a #e "a cica%ri+acin c&n e""& "a n!ea *&r'acin #e )!e&.

L& 'e6&re re!"%a#& e &0eran a" a("icar"& en *&r'a c&'0ina#a. 9:

F&r'a #e &0%encin2

Ree8a )i%rica2

A (ar%ir #e "& a8& >, !n gr!(& #e ine%iga#&re #irigi#& (&r Mar$ R.E. 9;:, e%!#ian#& e"

c&'(&r%a'ien%& #e" e"e'en%& #e "a angre re(&na0"e #e "a re(aracin ce"!"ar, "a ("a-!e%a,

enc&n%rar&n a" 'en& %re *ac%&re #e creci'ien%&.

Para "a &0%encin #e "& *ac%&re #e creci'ien%& e c&"&ca0a !n ca%1%er en&& cen%ra", e$%raen#&

#e >> a ?> '" #e angre, e agrega0a !n an%ic&ag!"an%e2 C.P.D. 9 ci%ar%e ()&()a%e #e$%r&e :.

En !na (r&(&rcin #e ; '" #e C.P.D. (&r ca#a ? '". #e angre. Cen%ri*!ga a ?.>> r(' c&n !na

e"&ci#a# #e &0%encin #e ?> '" (&r 'in!%&. Se e(ara0a

a4 "& %re c&'(&nen%e ang!4ne&2 ca(a eri%r&ci%aria a0a6&, P.R.P. 9 ("a'a ric& en ("a-!e%a:

%a'0i1n ""a'a#& 0!** c&a% en e" cen%r& P.P.P. 9("a'a (&0re en ("a-!e%a: arri0a.


11/17

Fig!ra '" #e P.P.P., &0re > #e P.R.P., &0re ;> #e )e'a%4e. Una e+ rec&gi#a "a

ca(a #e P.P.P. e 0a6an "a re&"!ci&ne #e "a cen%ri*!gacin a > (ara c&neg!ir !na

e(aracin (recia #e" P.R.P. "a erie r&6a. E" re%& #e "a e$%raccin , P.P.P., erie r&6a e

rein%r!ci#& a" (acien%e (&r e" 'i'& ca%1%er a %ra1 #e !na 4a (eri*1rica.

Para a("icar e" P.R.P. e re-!iere iniciar e" (r&ce& #e c&ag!"acin c&n !na 'e+c"a #e ;> '". #e

c"&r!r& c/"cic& a" ;> c&n %r&'0ina 0&ina %(ica #e ;>.>>> !ni#a#e 9Gen%rac:.

E" (r&%&c&"& (ara !%i"i+ar e" P.R.P., re-!iere !ar 6eringa in#ii#!a"e (ara ca#a 'e+c"a, -!e

c&n%iene #e" &r#en #e '", #e P.R.P., ; '". #e "a 'e+c"a #e c"&r!r& c/"cic& %r&'0ina ; '". #e

aire (ara c&'("e%ar e" (r&ce&. La 6eringa e agi%a #!ran%e 5;> eg!n#& (ara )&'&genei+ar e"

(r!c%& #e *&r'a -!e e" P.R.P., a)&ra en *&r'a #e ge", e (!e#a a8a#ir c&n e" 'a%eria" #e re""en&

c&n e" in6er%& (ara -!e e" cir!6an& re'e"e "a rec&n%r!ccin.9?:

Ani%!a.E.9;: !%i"i+a0a P.R.G.F. 9("a'a ric& en *ac%&re #e creci'ien%&:c&'& (re(aracin #e

*!%!r& "ec)& (ara i'("an%e. Dic)& P.R.G.F. "& &0%en4a e$%raen#& '" #e angre #e ca#a

(acien%e !an#& %!0& #e ? '". c&n%enien#& e" ;> #e ci%ra%& %ri#ic& c&'& an%ic&ag!"an%e.

L& %!0& eran cen%ri*!ga#& a ;> G #!ran%e 'in!%& a %e'(era%!ra a'0ien%e. La angre era

a4 e(ara#a en ! %re e"e'en%& 0/ic&. La erie r&6a a0a6&, e" ("a'a ric& en *ac%&re #e

creci'ien%&, en e" cen%r& e" ("a'a (&0re en *ac%&re #e creci'ien%& arri0a. Un& #e ca#a cinc& '"

#e ("a'a (&0re era #eec)a#&.

E" ("a'a re%an%e era rec&gi#& inc"!en#& ;5< '" #e c1"!"a r&6a #e "a (ar%e !(eri&r %ran*eri#&

a %!0& E((en#&r*, #&n#e "e a8a#4an ?> L. #e c"&r!r& c/"cic& a" ;> . De(!1 #e ;?5 'in!%&

a#-!ir4a "a c&ni%encia #e ge". E" %ie'(& #e a("icacin e e%an#ari+ en%re ? ;> 'in!%&. 9?:

De e%e '& e i'("i*ic "a %1cnica, ac&r%an#& %ie'(&, necei%an#& 'en& can%i#a# #e angre

#e" (acien%e a0ara%an#& c&%&.


12/17

T1cnica ac%!a"2

Se e$%raen en%re ;> ?> cc #e angre #e" (acien%e, &0%enien#& !n &"!'en (r&(&rci&na" a" ca&

-!ir7rgic&, ien#& !*icien%e ?> cc (ara "& en& 'a$i"are.

Una e+ e$%ra4#a "a angre e c&"&ca en !n reci(ien%e e%1ri" #e ("/%ic& & 4#ri& i"ic&na#&, 6!n%&a !na &"!cin #e ci%ra%& #e i& c&'& an%ic&ag!"an%e.

Se cen%ri*!ga #!ran%e 3 'in!%& &0%enien#& %re ca(a #e e#i'en%acin.

Se (i(e%ea "a ca(a !(eri&r a'0ar %ran(aren%e, &0%enien#&e e" P"a'a P&0re en P"a-!e%a.

9PPP:.

Se (i(e%ea "a (ar%e 'e#ia !n (&c& #e "a r&6a (&r-!e a)4 e%/n "a ("a-!e%a 'a 6ene, e

&0%ienen P"a'a Ric& en P"a-!e%a 9PRP:.

La in*eri&r, #&n#e e%/n "& g"0!"& r&6&, e #ecar%a.

Se c&nera a %e'(era%!ra a'0ien%e #!ran%e )&ra &


13/17

Fig!ra 2 Ma%eria" e$%raccin ang!4nea, i%e'a ac!%ainer 9B:

E" (ri'er ca'(& #&n#e e )a (!e%& en (r/c%ica e%a %1cnica )a i#& en "a cir!g4a &ra". C&n e%a

e%ra%egia e )a c&neg!i#& -!e !na e$%raccin #en%aria cica%rice en 'en& #e "a 'i%a# #e %ie'(&

#e *&r'a '/ in#&"&ra, #i'in!en#& n&%a0"e'en%e "& rieg& #e in*eccin en *!'a#&re,

#ia01%ic&, e%c. Ta'0i1n e !%i"i+a (ara c&rregir #e*ec%& e& a"re#e#&r #e i'("an%e #en%a"e. 9B:

A (ear #e -!e e" PRP e re%ringe a (e-!e8a rec&n%r!cci&ne, (ara 'e6&rar "a ca"i#a# #e")!e& c!an#& e (rac%ica !n in6er%& en +&na c&ncre%a, "& e$(er%& n& #ecar%a "a (&i0i"i#a# #e

-!e en e" *!%!r& e !e (ara gran#e rec&n%r!cci&ne. N& &0%an%e, e enaan &%ra

(&i0i"i#a#e #e &0%ener *ac%&re #e creci'ien%& e&, c&'& "a (r&%e4na '&r*&gen1%ica ea

9=MP:. 9:

N& &0%an%e, "& e(ecia"i%a c&ni#era -!e "a %1cnica (!e#e ""egar a e'("eare en n!'er&&

ca'(&. a e )a c&neg!i#& e%i'!"ar "a &%e&g1nei #e(!1 #e "a e$%ir(acin #e -!i%e

gracia a" e'("e& #e" ("a'a ric& en *ac%&re #e creci'ien%&. A#e'/, (!e#e re!"%ar #e gran

a!#a en "a *i6acin #e i'("an%e #e ca#era ri""a, a" crear !na in%er*ae (r&%eica en%re e" )!e&

"a (r%ei . O%ra (&i0"e a("icaci&ne #e "a %1cnica er4an "a c&n&"i#acin #e *rac%!ra "a

cica%ri+acin #e -!e'a#&. 9B:

Re!"%a#&2

L& re!"%a#& &0%eni#& (&r Ani%!a en !n e%!#i& c&n ;.>> i'("an%e #e'!e%ran -!e e" e'("e&

#e e%a !%ancia a!%"&ga 'e6&ra !n ;B (&r cien%& "a a(&icin ea a "& #& 'ee, e #ecir, "a

a#)erencia #e" )!e& e


14/17

)i%&"gica'en%e -!e rea"'en%e e$i%4a !n creci'ien%& e& !na 'e6&r #eni#a# #e )!e&

%ranc!rri#& ei 'ee #e(!1 #e "a rea"i+acin #e" e%!#i&. De e%a *&r'a, "a %aa #e *&r'acin

ea c&n PRP *!e #e ;,< a


15/17

C2 Decri(cin #e "a regeneracin ea "&gra#a gracia a "a c&"&cacin #e e5PTFE c&'& 0arrera,

*a&recien#& "a (r&"i*eracin #e "a c1"!"a (r&geni%&ra ea.

De*ec%& e& (r&&ca#& a" c&"&car i'("an%e en !n re0&r#e c&n rea0&rcin aan+a#a.

C&"&cacin #e !n i'("an%e en !na cre%a A"e&"ar #e"ga#a, ca!an#& !n #e*ec%& e&.

Fene%racin ea ca!a#a (&r "a c&"&cacin #e !n i'("an%e. 9;B:

C&"&cacin #e I'("an%e c&n 'e'0rana re""en& e&

C&"&cacin #e i'("an%e 'e'0rana.


16/17

Me'0rana c&"a(a#a.

C&"&cacin #e 'e'0rana, e 'an%iene e" e(aci&, ei%an#& -!e "a 'i'a c&"a(e.

C&"&cacin #e i'("an%e, c&n re""en& 'e'0rana PTFE, #e0i#& a #e*ec%& e&. 9;B:

Reerencias bibliogr!icas

;: KI'("an%&"&g4a c&n%e'(&r/neaK, Car" E. Mic) A8& ;?, E#i%&ria" M&0 D&'a Li0r&

>,

I'(ren%a Gr/*ica, C&'&r& Ria#aia.

B: KN!ea %1cnica #e regeneracin ea c&n !na !%ancia a!%"&gaK, Diari& M1#ic&. E#!ar#&

Ani%!a5Ga0rie" L&(e+.)%%(233QQQ.#iari&'e#ic&.c&'3e#ici&n3n&%icia3>,


17/17

GOMEZ CASAL, Francic& 2 He'a%"&g&. MORENO CHULILLA, &1 An%&ni&2 He'a%"&g&.

MARIN MELERO, S&nia2 O#&n%"&ga (eri&nci%a. CATIJIELA OTAL, Encarnacin 2 %1cnic& #e

"a0&ra%&ri&.

)%%(233QQQ.aii(5&n"ine.c&'3ar%ic!"&T$%.)%'"

: PRGF S%e'2 %1cnica #e &0%encin #e ("a'a ric& en *ac%&re #e creci'ien%&.

)%%(233QQQ.gace%a#en%a".c&'3'ar+&>;3(r!c%&3;: PRP 5 P"a'a Ric& en P"a-!e%a2Para 'e6&rar "a cica%ri+acin #e %e6i#& 0"an#& e&.

)%%(233QQQ.c!raan.#e3e(an&"3(r!c%&3(r(V*ac%&re.)%'"

;;: KI'("an%&"&g4a #e" n!e& 'i"eni&K Rana""i, Ocar A"0er%&. >

técnica de regeneración Ósea

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