Riabitazione degli innesti spongiosi e tecniche di stimolazione

Bone regeneration is based upon the three components of osteoconduction, osteoinduction and osteogenesis. During last years several bone substitutes have been developed to obtain a graft with ideal osteoconductive capabilities. Osteogenesis too has been emphasized with the progress of tissue engineering. Osteoinduction and the intrinsic osteoinductive properties of native bone have been already stressed by the historical works of Marshall Urist in 1965 about demineralised bone matrix (DBM). Only 20 years later the genetic sequences of the bone morphogenetic proteins (BMP) were identified and classified with the identification of a number of different BMPs whose precise role in the osteoinduction process is still extensively studied and not well defined. But experimental and preclinical studies have shown also that the BMPs are not playing alone on this stage. A lot of proteins secreted by the cells are implied in the process of healing and new bone formation; to these factors has been generically assigned the term of growth factors and an increasing number of these have been identified and used in experimental studies. The more debated are the transforming growth factor beta (TGF-β), the fibroblast growth factor (FGF), the insuline-like growth factor (IGF) and the platelets derived growth factors (PDGF). Obviously these are only some of the variety of factors that participate together with BMPs in a normal healing process.