| Abstract | Cijeljenje se klinički može klasificirati u tri tipa: primarno, sekundarno te tercijarno.
Sam proces odvija se tijekom triju faza: upalna, fibroblastična i faza sazrijevanja
(remodelacije).
U upalnoj fazi stvara se krvni ugrušak koji zaustavlja krvarenje, „zatvara“ ranu i postaje osnova
u koju urastaju nove epitelne stanice i fibroblasti. Osigurava se čišćenje rane, uklanjanje
nekrotičnog tkiva i bakterija. Makrofagi otpuštaju faktore rasta i citokine koji promiču
migraciju, proliferaciju i diferencijaciju mezenhimalnih stanica.
Fibroblastična faza karakterizirana je formiranjem granulacijskog tkiva bogatog upalnim
stanicama, fibroblastima i novim krvnim žilama, stoga se procesi ove faze nazivaju fibroplazija
i angiogeneza. Krajem fibroblastične faze taloži se preteča budućeg zrelog kolagena – kolagen
tipa III.
U posljednjoj fazi dolazi do kontrakcije rane. Osim toga, prethodno stvoreni nezreli kolageni
matriks biva zamijenjen zrelim i jačim kolagenom tipa I, stoga je i sama faza nazvana faza
sazrijevanja.
Sva oralna tkiva, uključujući oralnu sluznicu, živce, kost i koštane alveole prolaze kroz
navedene faze cijeljenja uz manje razlike karakteristične za određenu vrstu tkiva.
Komplikacije cijeljenja pojava je infekcije u području rane te tenzija i dehiscijencija koje utječu
na uspješnost „zatvaranja“ rane.
Lokalni čimbenici kao što su prisutnost stranog tijela, nekrotičnog tkiva i ishemija ozlijeđenog
područja mogu usporiti i otežati ili čak onemogućiti zacjeljenje.
Pacijentova dob, prehrambene navike, navike poput pušenja te određena sistemska stanja i
bolesti svrstavaju se u opće čimbenike koji se odražavaju na sposobnost cijeljenja.
Stoga se u svrhu poboljšanja cijeljenja primjenjuju pripravci iz skupine trombocitnih preparata
(PRP, PRGF ili PRF) ili pak hiperbarična oksigenacija kojom se povećava doprema kisika u
tkiva i na taj način poboljšava cijeljenje. |
| Abstract (english) | Healing can clinically be classified into three types: primary, secondary, and tertiary.
The process of healing is divided into three phases: inflammatory, fibroblastic, and remodeling
(maturation) phase.
In the inflammatory phase a blood clot forms which stops bleeding, “closes” the wound, and
becomes the matrix in which new epithelial cells and fibroblasts grow. Wound cleaning,
removal of necrotic tissue, and bacteria are ensured. Macrophages release growth factors and
cytokines that promote mesenchymal cell migration, proliferation, and differentiation.
The fibroblastic phase is characterized by the formation of granulation tissue rich in
inflammatory cells, fibroblasts, and new blood vessels. Therefore, the processes of this phase
are called fibroplasia and angiogenesis. At the end of the proliferation phase, the precursor of
the future mature collagen, collagen type III, is deposited.
In the last phase, the wound contracts. Also, the previously formed immature collagen matrix
is replaced by a mature and stronger type I collagen. Therefore, the phase itself is called the
maturation phase.
All oral tissues, including oral mucosa, nerves, bone, and bone alveoli undergo these stages of
healing with minor differences in particular tissue types.
The appearance of infection in the wound area, tension, and dehiscence which affect the success
of “closing” the wound are the complications that can occur during healing.
Local factors such as the presence of the foreign body, necrotic tissue, and ischemia of the
injured area can slow the healing down, make it difficult, or even impossible.
The patient's age, eating habits, habits like smoking, and certain systemic conditions and
diseases are classified as general factors that affect the ability to heal. Therefore, in order to
improve healing, preparations from the group of the platelet concentrates (PRP, PRGF or PRF)
or hyperbaric oxygenation are used as they increase the delivery of oxygen to the tissues and
consequently improves healing. |
