Third molar tooth bud albation

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关于第三磨牙一直有需不需要预防性拔除的争议。这篇文章从预防性拔除的角度来说，可能是走在时间线最前面的。作者成立了一家公司叫做TriAgenics，这个产品已经在走上市的流程了貌似。

没有获得全文，只有原文摘要放在下面。看到这篇文章的朋友，如果能够获得原文，希望可以通过页脚“联系”中的邮箱把原文发我一份，多谢。

Article information:

Leigh E. Colby, David P. Watson. Fully Guided Tooth Bud Ablation in Pigs Results in Complete Tooth Bud Removal and Molar Agenesis, Journal of Oral and Maxillofacial Surgery, Volume 81, Issue 4, 2023, Pages 456-466, https://doi.org/10.1016/j.joms.2022.12.009.

Abstract

Purpose

Fully guided microwave tooth bud ablation has the potential to become a minimally invasive means for managing third molars in adolescent patients. If developed, this new modality could provide improved outcomes and reduced complications compared to traditional third molar management strategies. The purpose of this 28-day longitudinal characterization study was to determine if the healing response following fully guided microwave ablation of second molar tooth buds in juvenile pigs would result in the complete removal of targeted tooth bud tissues, molar agenesis, and no significant collateral tissue damage.

Methods

Investigators performed fully guided microwave ablation on 24 mandibular second molar tooth buds (#18 and #31) in seven-week-old pigs. Postablation healing assessment consisted of radiographic and histological evaluation of 3 subcohorts (consisting of 4 animals each) at 7-, 14- and 28-days post ablation. Controls were untreated, opposing maxillary second molar tooth buds. Neurological assessment was performed to determine if there was any detectible loss of inferior alveolar nerve function.

Results

Healing processes were nearly complete at 28 days post ablation. While one tooth bud was identified as partially ablated at 14 days post treatment, all treated tooth bud tissues were replaced with trabecular new bone formation by the end of this study. There was no detectible loss of inferior alveolar nerve function. The thermal dosing strategy used in this study appears to deliver prescribed ablation volumes and—within the context of this animal model—there was no detected collateral tissue damage.

Conclusions

The results of this study confirm the hypothesis that healing processes following fully guided tooth bud ablation resulted in removal of targeted tooth bud tissues, complete molar agenesis, and trabecular new bone growth at 28-days post treatment.

Thanks to my friend K.X. Yan for providing a copy of this article.

Details for Fully Guided Tooth Bud Ablation

I was curious about the methods they’d use to deliver energy to the tooth bud to destroy it. I thought it might be cool if they used devices that produced non-contact heating. The thermal energy in the Tooth Bud Ablation (TBA) procedure was delivered to the target tooth bud using a microwave ablation system. A "proprietary TBA probe that was 2 mm in diameter" was used. This probe is the device that physically delivers the microwave energy to the tooth bud.

What is TBA (Tooth Bud Ablation) Treatment?

TBA, or Tooth Bud Ablation, as described in this study, is a minimally invasive experimental procedure aimed at preventing the development of third molars (wisdom teeth) and potentially other teeth. In this specific research, it was used on second molar tooth buds in juvenile pigs as a model for human third molars.

The core principle of TBA in this study is to use microwave energy to induce thermonecrosis (tissue death due to heat) in the tooth bud. The goal is to completely destroy the tooth bud tissue before it fully develops into a tooth, leading to molar agenesis (failure of the molar to develop).

Key aspects of TBA treatment in this study:

  • Microwave Energy: A proprietary microwave generator delivering 12 GHz microwave energy was used to heat and ablate the tooth bud tissue.
  • Thermonecrosis: The microwave energy is designed to cause controlled heating of the tooth bud, leading to tissue death without charring or carbonization, by keeping tissue temperatures below 100°C.
  • Minimally Invasive: Compared to surgical extraction of developing teeth, TBA is intended to be less invasive, potentially reducing complications and improving healing.
  • Preventative: TBA is envisioned as a preventative measure performed in adolescents before the tooth fully forms, aiming to avoid future problems associated with third molars, such as impaction and related complications.

Energy Dosing Strategy:

The researchers used a specific and carefully calculated energy dosing strategy to ensure effective ablation while minimizing collateral damage. Here’s how they determined and applied the energy:

  1. CBCT Scan Measurement: Before the procedure, Cone Beam Computed Tomography (CBCT) scans were taken of the pigs’ mandibles to image the second molar tooth buds.
  2. Bony Crypt Diameter Measurement: Using software like Blue Sky Plan, they measured the maximum diameters of the bony crypts (the sockets surrounding the developing tooth buds) in three dimensions: rostral/caudal, dorsal/ventral, and right/left.
  3. Energy Dose Calculation: These diameter measurements were used to determine the appropriate microwave energy dose for each targeted tooth bud. The goal was to deliver an energy dose that would create a spherical zone of ablation extending approximately 1 mm beyond the maximum diameter of the bony crypt.
  4. Ablation Zone Target Size: For example, in the case of tooth bud #18 in animal 1504, the maximum measured bony crypt diameter was 5.2 mm. The energy dose was chosen to create an ablation zone of 7.2 mm in diameter (5.2 mm + 1 mm margin on each side).
  5. Treatment Time: The targeted tooth bud #18 was treated for 30 seconds to deliver the calculated energy dose for the desired 7.2 mm ablation zone.
  6. Probe Depth Control: Surgical guide reports provided by the dental lab specified the total insertion depth of the TBA probe needed to reach the center of ablation within each tooth bud. This depth control was crucial for accurate energy delivery.

What does "Fully Guided" mean and how was the procedure guided?

"Fully guided" in this context refers to the precise, image-guided approach used to deliver the microwave ablation energy to the targeted tooth bud. The guidance was achieved through a combination of CBCT imaging and custom-made surgical guides:

  1. CBCT Imaging for Planning: CBCT scans were essential for visualizing the tooth bud and its surrounding bony crypt in 3D. This allowed for accurate measurement of the tooth bud’s location, size, and orientation.
  2. Surgical Guide Design and Fabrication: Based on the CBCT scans and dental impressions, tooth-supported quadrant surgical guides were designed using CAD/CAM software (CoDiagnostiX) and 3D-printed. These guides were custom-made for each animal, ensuring a precise fit on the teeth and bone.
  3. Surgical Guide Function: The surgical guide served as a template to:
    • Direct Osteotomy: It guided the creation of a small osteotomy (bone opening) using a bone drill to access the tooth bud.
    • Guide Probe Insertion: It had a channel specifically designed to precisely direct the TBA probe to the center of the targeted tooth bud at the pre-calculated depth. This ensured accurate positioning of the ablation zone within the tooth bud.
    • Probe Insertion and Ablation: The 2mm diameter TBA probe was inserted through the channel in the surgical guide until it reached the predetermined depth, ensuring the center of the ablation zone was located precisely in the center of the tooth bud. Microwave energy was then delivered.

Detailed Steps of the Guided Procedure:

  1. Preoperative CBCT Scan: A CBCT scan of the pig’s mandible and maxilla was obtained to visualize the second molar tooth buds.
  2. Dental Impressions: Mandibular quadrant dental impressions were taken.
  3. Surgical Guide Design: Using the CBCT scans and impressions, surgical guides were designed using CAD/CAM software (CoDiagnostiX). The design incorporated a pathway for the TBA probe to reach the center of the targeted tooth bud.
  4. 3D Printing of Surgical Guides: The designed surgical guides were 3D printed overnight.
  5. Anesthesia and Nerve Assessment: On the day of surgery, the pig was anesthetized, and a neurological assessment of the inferior alveolar nerve was performed.
  6. Preoperative Photos: Photos were taken before the procedure.
  7. Surgical Guide Placement: The appropriate surgical guide (left or right mandibular) was positioned in the pig’s mouth, supported by the existing teeth.
  8. Osteotomy Creation: Using the surgical guide as a template, a small osteotomy was created with a sterile 2mm orthopedic bone drill. The drill was guided through a channel in the surgical guide, ensuring precise access to the tooth bud.
  9. Debridement (Bone Chips Removal): Any bone chips or tissue debris from the osteotomy were removed from the surgical guide pathway.
  10. TBA Probe Insertion: The proprietary 2mm TBA probe was immediately inserted through the surgical guide pathway to the pre-determined depth. The guide ensured the probe was accurately positioned at the center of the tooth bud.
  11. Microwave Energy Delivery: The pre-calculated microwave energy dose was delivered through the probe for a specific duration (e.g., 30 seconds for tooth bud #18).
  12. Post-Ablation Photos: Intraoral photos of the probe insertion site were taken.
  13. Recovery and Analgesia: The animal was placed in recovery and given analgesics (meloxicam) for 3 days to manage any potential discomfort.

In summary, the "fully guided" nature of this TBA procedure relies on the precise planning using CBCT imaging and the physical guidance provided by custom-made surgical guides. This approach aimed to deliver microwave energy accurately to the target tooth bud, maximizing ablation efficacy while minimizing damage to surrounding tissues.

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