COVID-19-Triggered Acute Liver Failure and Rhabdomyolysis: A Case Report and Review of the Literature.

COVID-19 is primarily known for its respiratory tract involvement, often leading to severe pneumonia and exacerbation of underlying diseases. However, emerging evidence suggests that COVID-19 can result in multiorgan failure, affecting organs beyond the respiratory system. We present the case of a 62-year-old male with COVID-19 who developed acute liver failure (ALF) and rhabdomyolysis in the absence of respiratory failure. Initially, the patient presented with significantly elevated aspartate transaminase (5398 U/L) and alanine transaminase (2197 U/L) levels. Furthermore, a prolonged prothrombin time international normalized ratio (INR) of 2.33 indicated the diagnosis of ALF without hepatic coma, according to Japanese diagnostic criteria. The patient also exhibited elevated creatine kinase (9498 U/L) and a mild increase in creatinine (1.25 mg/dL) levels, but both values improved with intravenous fluid support and molnupiravir administration. To our knowledge, this is the first reported case presenting with both ALF and rhabdomyolysis associated with COVID-19. In addition, we review the existing literature to summarize previously reported cases of ALF triggered by SARS-CoV-2. This case report underscores the significance of recognizing COVID-19 as a significant contributing factor in the development of multiorgan failure. Furthermore, it suggests that COVID-19 can lead to severe illness, irrespective of the absence of respiratory failure.

Versatile delivery platform for nucleic acids, negatively charged protein drugs, and genome-editing ribonucleoproteins using a multi-step transformable polyrotaxane.

Various biopharmaceuticals, such as nucleic acids, proteins, and genome-editing molecules, have been developed. Generally, carriers are prepared for each biopharmaceutical to deliver it intracellularly; thus, the applications of individual carriers are limited. Moreover, the development of carriers is laborious and expensive. Therefore, in the present study, versatile and universal delivery carriers were developed for various biopharmaceuticals using aminated polyrotaxane libraries. Step-by-step and logical screening revealed that aminated polyrotaxane, including the carbamate bond between the axile molecule and endcap, is suitable as a backbone polymer. Movable and flexible properties of the amino groups modified on polyrotaxane facilitated efficient complexation with various biopharmaceuticals, such as small interfering RNA, antisense oligonucleotides, messenger RNA, ß-galactosidase, and genome-editing ribonucleoproteins. Diethylenetriamine and cystamine modifications of polyrotaxane provided endosomal-escape abilities and drug-release properties in the cytosol, allowing higher delivery efficacies than commercially available high-standard carriers without cytotoxicity. Thus, the resulting polyrotaxane might serve as a versatile and universal delivery platform for various biopharmaceuticals.

Identification and Quantification of Jaundice by Trans-Conjunctiva Optical Imaging Using a Human Brain-like Algorithm: A Cross-Sectional Study.

Jaundice is caused by excess circulating bilirubin, known as hyperbilirubinemia. This symptom is sometimes caused by a critical hepatobiliary disorder, and is generally identified as yellowish sclera when bilirubin levels increase more than 3 mg/dL. It is difficult to identify jaundice accurately, especially via telemedicine. This study aimed to identify and quantify jaundice by trans-conjunctiva optical imaging. Patients with jaundice (total bilirubin ≥3 mg/dL) and normal control subjects (total bilirubin <3 mg/dL) were prospectively enrolled from June 2021 to July 2022. We took bilateral conjunctiva imaging with a built-in camera on a smartphone (1st generation iPhone SE) under normal white light conditions without any restrictions. We processed the images using an Algorithm Based on Human Brain (ABHB) (Zeta Bridge Corporation, Tokyo, Japan) and converted them into a hue degree of Hue Saturation Lightness (HSL) color space. A total of 26 patients with jaundice (9.57 ± 7.11 mg/dL) and 25 control subjects (0.77 ± 0.35 mg/dL) were enrolled in this study. The causes of jaundice among the 18 male and 8 female subjects (median age 61 yrs.) included hepatobiliary cancer (n = 10), chronic hepatitis or cirrhosis (n = 6), pancreatic cancer (n = 4), acute liver failure (n = 2), cholelithiasis or cholangitis (n = 2), acute pancreatitis (n = 1), and Gilbert's syndrome (n = 1). The maximum hue degree (MHD) optimal cutoff to identify jaundice was 40.8 (sensitivity 81% and specificity 80%), and the AUROC was 0.842. The MHD was moderately correlated to total serum bilirubin (TSB) levels (rS = 0.528, p < 0.001). TSB level (≥5 mg/dL) can be estimated by the formula 21.1603 - 0.7371 × 56.3-MHD2. In conclusion, the ABHB-based MHD of conjunctiva imaging identified jaundice using an ordinary smartphone without any specific attachments and deep learning. This novel technology could be a helpful diagnostic tool in telemedicine or self-medication.

The Characteristics and Prognosis of Alpha-Fetoprotein and Des-Gamma-Carboxy Prothrombin Double-Negative Hepatocellular Carcinoma at Baseline in Higher BCLC Stages.

Alpha-fetoprotein (AFP) and des-gamma-carboxyprothrombin (DCP) are widely used as tumor markers to diagnose hepatocellular carcinoma (HCC). Some advanced HCCs demonstrate neither AFP nor DCP. This study investigated the characteristics and prognosis of AFP (<20 ng/mL) and DCP (<40 mAU/ml) double-negative HCC (DNHC) in higher-stage HCC. Between April 2012 and March 2022, 419 consecutive patients were enrolled with newly diagnosed HCC and 372 patients were selected that were diagnosed by histopathology and/or imaging. AFP-negative, DCP-negative, and double-negative HCC were identified in 262 patients (70.4%), 143 patients (38.2%), and 120 patients (32.3%), respectively. In higher-BCLC stages (BCLC-B, C, and D), 17 patients (14.7%) were DNHC. Although there was no difference in BCLC staging, there were more cases under TNM Stage III in DNHC (71.0% vs. 41.4%, p = 0.026). The median maximum tumor diameter was smaller in DNHC [3.2 (1.8−5.0) vs. 5.5 (3.5−9.0) cm, p = 0.001] and their median survival time was significantly better, even in higher-stage HCC [47.0 (24.0−84.0) vs. 19.0 (14.0−30.0) months, p = 0.027). DNHC in higher-BCLC stage HCC is independent of BCLC staging, characterized by a tumor diameter < 5 cm, and is treatable with a good prognosis.

Designing anterior cantilever resin-bonded fixed dental prostheses based on finite element analysis.

PURPOSE: A resin-bonded bridge (RBB) is a minimally invasive prosthetic treatment option for intact adjacent teeth. However, it is contentious as to whether the mesial or distal adjacent tooth should be used as an abutment. This study aimed to investigate the potential of finite element analysis (FEA) for the selection of abutment teeth and the determination of the optimal design for anterior cantilever RBBs. METHODS: Three types of RBBs were designed to simulate loss of the maxillary left lateral incisor. The fixed-fixed RBB (FF-RBB) had one retainer each for the left central incisor and canine. Distal- and mesial-cantilever RBBs (D-CRBB and M-CRBB) had a single retainer on the central incisor and canine, respectively. Three-dimensional models for FEA were generated from computed tomography slices and dental casts. FEA was performed for each RBB to evaluate stresses in the intercuspal, protrusive, and lateral mandibular positions. RESULTS: The maximum principal stresses on the bridges in the intercuspal position were 141.9 MPa, 93.6 MPa, and 45.7 MPa, for the FF-RBB, D-CRBB, and M-CRBB, respectively. The stress in the D-CRBB position was greater than in the M-CRBB position in the intercuspal, protrusive, and lateral mandibular positions. CONCLUSIONS: Based on the results, M-CRBB on the canine had a higher clinical performance than D-CRBB on the central incisor. FEA was useful for determining the optimal design of RBB for each patient.

[Small duct primary sclerosing cholangitis diagnosed after fever and liver disorder: a case report].

A woman in her 10s presented to our hospital with persistent fever and liver disorder and was admitted. It was considered that her fever was due to infectious, hematological, and collagen diseases; however, these diseases were excluded. Upper and lower gastrointestinal endoscopy revealed gastritis and indicated inflammatory bowel disease involvement. Neither bile duct stricture nor bile duct wall thickening was observed in the imaging. Thus, liver biopsy was performed due to worsening liver disorder. A diagnosis of small duct primary sclerosing cholangitis was made based on the findings of edematous enlargement of the portal tracts, neutrophilic infiltration, and destruction of the interlobular bile ducts. Furthermore, liver biopsy is helpful in diagnosing unknown liver disorders, even if no abnormality in the bile duct is observed on imaging.

Chronic Active Epstein-Barr Virus Infection Indistinguishable from Autoimmune Hepatitis: A Case Report.

Chronic active Epstein-Barr virus (CAEBV) infection is a rare disease, mainly affecting children, typically characterized by persistent infectious mononucleosis (IM)-like symptoms. We describe an adult case of CAEBV without IM-like symptoms, which was indistinguishable from autoimmune hepatitis (AIH). A 60-year-old woman with liver damage was diagnosed with AIH (International Diagnostic Score: 16 points). She had been treated with prednisolone for three years; however, her transaminases had never normalized. She was admitted for another liver biopsy due to repeated high fevers and worsening of her liver damage over two months. Her EBV-DNA copy number was 2.9 × 104 copies/µg DNA, and EBV-encoded small RNA1-positive lymphocytic infiltration was observed in both the present and previously collected (three years ago) liver tissue samples. This case implies that hepatic involvement in a CAEBV without IM-like symptoms is difficult to distinguish from AIH and may be misdiagnosed. In some steroid resistant AIH cases, evaluating for CAEBV may be valuable.

Fabrication of mucocompressive splints for free gingival grafts via medical engineering in patients with reconstructed mandibles.

PURPOSE: Acquiring adequate attached mucosa is important in restoring masticatory function with a removable dental prosthesis or dental implant. In patients with inadequate attached mucosa, a free gingival graft (FGG) with a custom stent is used. However, it is challenging to apply the conventional method for fabricating a stent with a reshaped cast in patients with reconstructed mandibles because the reconstructed mandible has limitations due to a titanium mesh, skin flap, and unique bone morphology. In the present report, we have proposed a new design and fabrication process for a mucocompressive splint via medical engineering to acquire the attached mucosa for the prosthodontic treatment of reconstructed mandibles. METHODS: Three-dimensional (3D) craniomandibular models were reconstructed from a computed tomography dataset after mandibular reconstruction. The dentition region was replaced with highly precise scan data of the dental casts using a 3D scanner. The alveolar ridge mucosa and teeth were ideally designed using the 3D model while referring to the anatomical structures. The jig used to fabricate the working dental cast with artificial gum in real space was designed and fabricated using a 3D printer. The alveolar ridge was altered into a simulated configuration on the articulator using a jig. A mucocompressive splint was fabricated on an altered dental cast. The splint was immediately seated on the mandible without any major adjustments after the FGG. CONCLUSION: Adequate attached mucosa for the prosthodontic treatment of a reconstructed mandible was obtained by the pre-surgical fabrication of a mucocompressive splint through medical engineering.

Considerations for the selection of interim restoration materials using wear test results.

PURPOSE: The purpose of this study was to examine the wear of resin materials using two-body wear tests and to verify a selection method for optimal interim restoration materials from findings of a diagnostic occlusal device. METHODS: Specimens were prepared from nine different resins used for diagnostic occlusal devices (soft resin) and interim restorations. Wear tests were conducted using an abrasion testing machine. The resulting wear on resin specimens and antagonist stainless-steel styluses was measured using a laser confocal scanning microscope, and the surface conditions were observed through a scanning electron microscope. The data were analyzed with one-way ANOVA and Tukey's multiple comparison test. The findings of the previous study on diagnostic occlusal devices were referred to in order to verify the selection method of optimal interim restoration materials. RESULTS: The maximum wear depth of the soft resin specimens was significantly greater than that of the other specimens (p<0.05) and was equivalent to the wear depth of a diagnostic occlusal device used for 14 nights. The wear of bis-acryl resin material was shallower than that of the other materials (Polymethyl methacrylate and polyethyl methacrylate), and its antagonist stylus was significantly worn (p<0.05). CONCLUSION: The findings of the previous and present studies showed a relationship among the parameters of Electromyography, wear depth of the diagnostic occlusal device, and wear of materials used for interim restorations. Findings related to bruxism can guide in the selection of interim restoration material and the determination of a suitable duration of wear.

Pemafibrate Ameliorates Liver Dysfunction and Fatty Liver in Patients with Non-Alcoholic Fatty Liver Disease with Hypertriglyceridemia: A Retrospective Study with the Outcome after a Mid-Term Follow-Up.

Non-alcoholic fatty liver disease (NAFLD) is a chronic liver disease related to metabolic syndrome. No standard pharmacological treatment has yet been established. We retrospectively evaluated the efficacy of pemafibrate in 16 NAFLD patients (11 men and 5 women; median age, 59 years; range, 27-81 years) who had taken pemafibrate for at least one year. They were all diagnosed with fatty liver according to imaging and clinical criteria. They were administered pemafibrate from October 2018 to October 2021 (median, 94 weeks; range, 56-157 weeks). Serum triglyceride was significantly decreased by -41.9% (342.3 ± 54.0 to 198.9 ± 20.4 mg/dL, p < 0.001). Aspartate aminotransferase (AST), alanine aminotransferase, and gamma-glutamyl transferase levels significantly decreased by -42.1% (49.6 ± 7.0 to 28.7 ± 3.4 U/L, p < 0.001), -57.1% (65.1 ± 10.8 to 27.9 ± 3.7 U/L, p < 0.001), and -43.2% (68.9 ± 10.9 to 39.1 ± 5.3 U/L, p < 0.05), respectively. The AST to platelet ratio (APRI) (0.8 ± 0.1 to 0.4 ± 0.1, p < 0.001) and fibrosis based on four factors (FIB-4) index (1.8 ± 0.3 to 1.4 ± 0.2, p < 0.05) also significantly decreased. Liver attenuation (39.1 ± 1.2 to 57.8 ± 2.7 HU, p = 0.028) and liver/spleen ratio (0.76 ± 0.04 to 1.18 ± 0.02, p = 0.012) significantly improved in three patients, as assessed by computed tomography. In conclusion, pemafibrate significantly improves serum triglyceride levels, liver function, FIB-4 index, APRI, and fatty liver in NAFLD patients with hypertriglyceridemia.

Simulation and navigation of living donor hepatectomy using a unique three-dimensional printed liver model with soft and transparent parenchyma.

Three-dimensional printed liver models have been used for preoperative simulation. Unlike the standard three-dimensional system on a monitor, the three-dimensional printed model can be observed from any angle manually; therefore, surgeons can obtain a clear image directly from the model. We herein report the use of a unique three-dimensional liver model with a soft and transparent liver parenchyma. Through the parenchyma, the surgeons can observe the intrahepatic vessels and perform incisions in the model as a preoperative simulation. In this study, we applied this model to donor hepatectomy, which under most circumstances requires meticulous attention to detail. The actual processes and uses of a three-dimensional liver model in clinical surgery for liver transplantation are presented.

Effect of bovine milk fermented with Lactobacillus rhamnosus L8020 on periodontal disease in individuals with intellectual disability: a randomized clinical trial.

OBJECTIVE: Studies on the oral health of individuals with intellectual disability (ID) have identified problems that include a high prevalence of periodontal disease. The use of probiotics to treat periodontal disease has been the focus of considerable research, and bovine milk fermented with Lactobacillus rhamnosus L8020 (L8020 yogurt) has been shown to reduce the oral prevalence of four periodontal pathogens. The aim of this randomized, double-blind, placebo-controlled trial was to compare the effects of L8020 yogurt (test group) with those of placebo yogurt (placebo group) on the papillary-marginal-attached (PMA) index, gingival index (GI), and probing depth (PD) in 23 individuals with ID. METHODOLOGY: All patients were required to consume the allocated yogurt after breakfast for 90 days. PMA index and GI scores as well as PDs were assessed before the start of yogurt consumption (baseline), after 45 and 90 days of consumption, and 30 days after the cessation of consumption. Student's t-test, Mann-Whitney U test or Fisher's exact test was used for inter-group comparisons, and the mixed effect model of repeated measurements was used for data analysis. RESULTS: The decrease in PMA index score was significantly greater in the test group than in the placebo group (p<0.001). The GI score also decreased during the study, with a tendency for greater decrease in the test group. Furthermore, decreases in PD between baseline, 45 and 90 days tended to be greater in the test group than in the placebo group. CONCLUSION: These results suggest that regular consumption of bovine milk fermented with L. rhamnosus L8020 can lower the risk of periodontal disease in individuals with ID.

Mandibular 3-dimensional finite element analysis for a patient with an aggressive form of craniofacial fibrous dysplasia.

The longitudinal change in mandibular volume and configuration was quantitatively evaluated in a patient with craniofacial fibrous dysplasia (FD). The influence of mechanical stress on the enlargement that is characteristic of FD was verified via finite element analysis (FEA). The patient was a 38-year-old man diagnosed with craniofacial FD in the mandible. He underwent surgical reduction of FD, but the lesion continued to grow and caused facial asymmetry and masticatory disturbance because of missing teeth. An occlusal overlay removable partial denture was constructed for his lower jaw. Computed tomography (CT) images were acquired 4 times in 10 years, and 3-dimensional (3-D) models were reconstructed from these data. The 3-D models were analyzed volumetrically and morphologically and used for FEA. The FD lesion in the mandible enlarged nonuniformly and had site specificity. From the results of FEA, it is suggested that compression stress induced by the occlusal force through the denture may have influenced the direction of enlargement in FD.

Effect of bovine milk fermented with Lactobacillus rhamnosus L8020 on periodontal disease in individuals with intellectual disability: a randomized clinical trial

Abstract Studies on the oral health of individuals with intellectual disability (ID) have identified problems that include a high prevalence of periodontal disease. The use of probiotics to treat periodontal disease has been the focus of considerable research, and bovine milk fermented with Lactobacillus rhamnosus L8020 (L8020 yogurt) has been shown to reduce the oral prevalence of four periodontal pathogens. Objective The aim of this randomized, double-blind, placebo-controlled trial was to compare the effects of L8020 yogurt (test group) with those of placebo yogurt (placebo group) on the papillary-marginal-attached (PMA) index, gingival index (GI), and probing depth (PD) in 23 individuals with ID. Methodology All patients were required to consume the allocated yogurt after breakfast for 90 days. PMA index and GI scores as well as PDs were assessed before the start of yogurt consumption (baseline), after 45 and 90 days of consumption, and 30 days after the cessation of consumption. Student's t-test, Mann-Whitney U test or Fisher's exact test was used for inter-group comparisons, and the mixed effect model of repeated measurements was used for data analysis. Results The decrease in PMA index score was significantly greater in the test group than in the placebo group (p<0.001). The GI score also decreased during the study, with a tendency for greater decrease in the test group. Furthermore, decreases in PD between baseline, 45 and 90 days tended to be greater in the test group than in the placebo group. Conclusion These results suggest that regular consumption of bovine milk fermented with L. rhamnosus L8020 can lower the risk of periodontal disease in individuals with ID.

Comparison of the bone regeneration ability between stem cells from human exfoliated deciduous teeth, human dental pulp stem cells and human bone marrow mesenchymal stem cells.

Cleft lip and palate is the most common congenital anomaly in the orofacial region. Autogenous iliac bone graft, in general, has been employed for closing the bone defect at the alveolar cleft. However, such iliac bone graft provides patients with substantial surgical and psychological invasions. Consequently, development of a less invasive method has been highly anticipated. Stem cells from human exfoliated deciduous teeth (SHED) are a major candidate for playing a significant role in tissue engineering and regenerative medicine. The aim of this study was to elucidate the nature of bone regeneration by SHED as compared to that of human dental pulp stem cells (hDPSCs) and bone marrow mesenchymal stem cells (hBMSCs). The stems cells derived from pulp tissues and bone marrow were transplanted with a polylactic-coglycolic acid barrier membrane as a scaffold, for use in bone regeneration in an artificial bone defect of 4 mm in diameter in the calvaria of immunodeficient mice. Three-dimensional analysis using micro CT and histological evaluation were performed. Degree of bone regeneration with SHED relative to the bone defect was almost equivalent to that with hDPSCs and hBMSCs 12 weeks after transplantation. The ratio of new bone formation relative to the pre-created bone defect was not significantly different among groups with SHED, hDPSCs and hBMSCs. In addition, as a result of histological evaluation, SHED produced the largest osteoid and widely distributed collagen fibers compared to hDPSCs and hBMSCs groups. Thus, SHED transplantation exerted bone regeneration ability sufficient for the repair of bone defect. The present study has demonstrated that SHED is one of the best candidate as a cell source for the reconstruction of alveolar cleft due to the bone regeneration ability with less surgical invasion.

Accuracy of a three-dimensional dentition model digitized from an interocclusal record using a non-contact surface scanner.

OBJECTIVES: For orthodontic treatment, it is important to assess the dental morphology, as well as the position and inclination of teeth. The aim of this article was to develop an efficient and accurate method for the three-dimensional (3D) imaging of the maxillary and mandibular dental morphology by measuring interocclusal records using an optical scanner. MATERIALS AND METHODS: The occlusal and incisal morphology of participants was registered in the intercuspal position using a hydrophilic vinyl polysiloxane and digitized into 3D models using an optical scanner. Impressions were made of the maxilla and mandible in alginate materials in order to fabricate plaster models and created into 3D models using the optical scanner based on the principal triangulation method. The occlusal and incisal areas of the interocclusal records were retained. The buccal and lingual areas were added to these regions entirely by the 3D model of the plaster model. The accuracy of this method was evaluated for each tooth, with the dental cast 3D models used as controls. RESULTS: The 3D model created from the interocclusal record and the plaster model of the dental morphology was analysed in 3D software. The difference between the controls and the 3D models digitized from the interocclusal records was 0.068±0.048mm, demonstrating the accuracy of this method. LIMITATIONS: The presence of severe crowding may compromise the ability to separate each tooth and digitize the dental morphology. CONCLUSIONS: The digitization method in this study provides sufficient accuracy to visualize the dental morphology, as well as the position and inclination of these teeth.

Application of photogrammetry for analysis of occlusal contacts.

INTRODUCTION: The conventional 2D-analysis methods for occlusal contacts provided limited information on tooth morphology. This present study aims to detect 3D positional information of occlusal contacts from 2D-photos via photogrammetry. We propose an image processing solution for analysis of occlusal contacts and facets via the black silicone method and a photogrammetric technique. MATERIALS AND METHODS: The occlusal facets were reconstructed from a 2D-photograph data-set of inter-occlusal records into a 3D image via photogrammetry. The configuration of the occlusal surface was reproduced with polygons. In addition, the textures of the occlusal contacts were mapped to each polygon. DIFFERENCE FROM CONVENTIONAL METHODS: Constructing occlusal facets with 3D polygons from 2D-photos with photogrammetry was a defining characteristic of this image processing technique. It allowed us to better observe findings of the black silicone method. Compared with conventional 3D analysis using a 3D scanner, our 3D models did not reproduce the detail of the anatomical configuration. However, by merging the findings of the inter-occlusal record, the deformation of mandible and the displacement of periodontal ligaments under occlusal force were reflected in our model. EFFECT OR PERFORMANCE: Through the use of polygons in the conversion of 2D images to 3D images, we were able to define the relation between the location and direction of the occlusal contacts and facets, which was difficult to detect via conventional methods. CONCLUSION: Through our method of making a 3D polygon model, the findings of inter-occlusal records which reflected the jaw/teeth behavior under occlusal force could be observed 3-dimensionally.

Influence of filler on bite impression material in transillumination method for occlusal examination.

The purpose of this present study was to investigate the influence of material filler and RGB values' fluctuation on creating a calibration curve, which indicates the relationship between material thickness and transmitted light brightness using the transillumination method. Creating the calibration curves were carried out through the following three methods; 1) the conventional method creates the calibration curve with a formula of thickness, 2) the maximum value method, with samples of a specified thickness, and 3) the actual value method, with a microscope. Furthermore, the reliability of each curve was verified via scanned artificial tooth data. In addition, the characteristics of light decrement were investigated. From our results, it was suggested that the filler diameter must be considered when the calibration curve is created using the bite impression material with a filler. In addition, it was suggested that the RGB values' fluctuation did not influence the calibration curve.

Construction of orthodontic setup models on a computer.

INTRODUCTION: Orthodontic setup models are usually limited to the display of teeth, with no information about the roots. The purpose of this article is to present a method for visualizing the tooth roots in setup models by integrating information from cone-beam computed tomography and a laser scanner. The reproducibility of the integration was evaluated. METHODS: The records of 5 patients were used in this study. Three-dimensional digital models were generated from the dental casts. Tooth models were generated from the cone-beam computed tomography slices. The 3-dimensional models were superimposed on the crowns of the teeth in the tooth models and integrated. The integrated 3-dimensional tooth model and 3-dimensional setup model were registered. The reproducibility of the integration was evaluated for each tooth. Unpaired Student t tests were performed on the data between the anterior and posterior teeth, and between the right and left teeth. RESULTS: The discrepancy among the integrated 3-dimensional models at the final positions after we used this technique was 0.025 ± 0.007 mm. There was a significant difference in the distance between the anterior and posterior teeth (P <0.05). However, the average distances between the anterior and posterior teeth were small: 0.023 ± 0.007 and 0.028 ± 0.007 mm, respectively. No significant difference was found between the right and left teeth (P = 0.831). CONCLUSIONS: The methods presented in this study provide a reproducible visualization of tooth roots in virtual setup models by registering accurate crown models to cone-beam computed tomography scans.