Monday, January 27, 2020
Approaches to Correction of Class III Skeletal Malocclusion
Approaches to Correction of Class III Skeletal Malocclusion Combined Orthodontic and Surgical Approach in the Correction of Class III Skeletal Malocclusion Dr. Abdulaziz AlShahrani Astrac While growth modification and camouflage orthodontic treatment offers a limited solution in treating some skeletal Class III malocclusion depending on the age of the patient , Underlying skeletal severity, alignment of the teeth and the vertical facial proportions, a combination of surgical and Orthodontic therapy is the treatment of choice in all severe skeletal Class III malocclusion. In this case report I present a combination of surgical-orthodontic therapy for an adult female patient with skeletal class III malocclusion which resulted in good skeletal, dental and soft tissue relationship, with marked improvement in function and facial esthetics. Keywords:Class III malocclusion, Orthognathic Surgery, surgical orthodontics Introduction Class III malocclusion is considered to be one of the most difficult and complex orthodontic problems to treat. The prevalence of class III malocclusion has been reported to be as low as 3-5% in the Caucasian population, but is higher in the Chinese and Japanese population (4-13%) (Often associated with maxillary retrusion)[i],[ii],[iii]. The etiology of class III is complex and multifactorial. However, there is usually a strong genetic contribution. Genetic factor is one of the etiological factors where one third of children with severe Class III had a parent with the same problem and one-sixth had an affected sibling[iv]. Racial tendency may play a role as the blacks have shown higher incidence than white’s[v].Environmental factors appear to play an adaptiverole in the etiology of Class III malocclusion[vi].Class III malocclusion can be associated with other factors such as cleft palate[vii]. Individuals with class III malocclusion show combinations of skeletal and dentoalveolar components. Class III malocclusion may occur as a result of protrusive mandible, retrusive maxilla, combination of both[viii]. While the most commonly found Class III malocclusion (30%) showed a combination of mandibular protrusion and maxillary retrusion, Maxillary retrusion alone was found in 19.5% of the sample and Mandibular protrusion alone was found in 19.1% of the sample[ix].These complex nature of class III requirea careful planning, amultidisciplinary approach and patient cooperation[x]. CaseReport A 17-year-old caucasian girl presented for orthodontic treatment because of referral from her dentist with primary complaint of un-esthetic facial and dental appearance. She has a hyper-divergent Class III skeletal and dental relationship. This is characterized by retrognathic maxilla, retroclined lower anterior teeth, with maximum active opening of 47mm with 5mm negative overjet and lateral excursions of 7 mm to both right and left sides. The patient has an ovoid, relatively asymmetrical face with chin slightly deviated to the left. The lip line at rest displayed approximately 2 mm of upper incisor. At full animation there was 7mm of upper incisal display and 2 mm of lower incisal edge. She has a slightly concave profile, and competent lips[Figure1]. Pretreatment extra oral photos Intraorally, the oral mucosa was healthy. There were no periodontal pockets present. The gingival tissues were inflamed especially around the prosthetic crowns. There was no bleeding tendency except sometimes with brushing. Free gingival margins were near to the CEJ and attached gingiva was of normal width throughout the mouth. The frenal attachments in both arches were normal. The tongue was normal in size, function and appearance. Teeth # 26, 36 and 46 have been crowned. There was a lingual arch placed one year ago to maintain lower incisors position. Occlusion analysis, she was in the permanent dentition and the 3rd molars were un-erupted. She has good oral hygiene. Frontal view: Shows a dental midline discrepancy. The lower dental midline is coincident with the facial midline while the upper midline is not coincident with the facial midline it’s off to the left by 2.5mm, the occlusal planewas slightly canted to the left. A negative overjet of 5 mm reported.Right and left Lateral Views Shows the canines and molars in Class III relationships. The upper occlusal view shows a U-shaped arch with well aligned anterior segment. The lower occlusal view reveals a U-shaped arch with crowding of 3.9mmà ¢Ã¢â€š ¬Ã¢â‚¬ ¹[Figure 2]. TREATMENT OBJECTIVES Our objective is to address compensated lower incisors by proclining them to the ideal position and inclination followed by increasing the horizontal projection of the maxilla to correct upper jaw retrognathism, concave profile, class III dental relationshipand negative overiet. Increased lower facial height and hyper-divergence will be corrected byautorotation of the mandible after the advancement of the maxilla and vertical reduction genioplasty.Mandibular asymmetry will be corrected by BSSO while maintaining lower incisor position. TREATMENT PROGRESS We started Pre-surgical orthodontics using self-ligation bracket system (Roth prescription, 022†slot). Leveling and alignment of maxillary and mandibular arches began with round 0.016 niti arch wires progressing to 0.0170.025 niti arch wires. Patient was referred to extract all 3rd molars at this stage. Coordinated 0.0190.025 Stainless steel then used for arch coordination before sending the patient for surgical procedure[Figures 67]. All the movement and prediction were planned on pre-surgical lateral cephalometric x-ray using Moorres mesh as a guide. A sheet of tracing paper over the original tracing and the outline of the mandible was drawn and trimmed making a template, another template for the maxilla was produced and placed in the post-surgical position. The mandibular autorotation then simulated accordingly. The soft tissue contours then drawn using the guidelines in literatures[xi],[xii],[xiii][Figure8]. Centric relationship of Upper and lower jaws was recorded and Face bow transfer and articulation of models on a semi-adjustable articulator was done. Model surgery then performed using Erickson model blockandacrylic inter occlusal wafer splint was produced. Le fort I osteotomywas performed to advance the maxilla for 7.1 mm and Bilateral sagittal split osteotomy was carried out to correct mandibular asymmetry while maintaining the A-P position of the mandible. Vertical reduction and advancement (4mm each) genioplastythen performed to address the increased lower facial height and achieve esthetically acceptable facial profile. Rigid type of fixations were used in both arches. The patient was followed closely and the post-surgical Orthodontic was resumed 3 weeks after surgery. 0.0190.025 stainless steel changed to 0.021 Ãâ€" 0.025stainless steel to express the torque. Finishing was performed with settling elastics[figures9-12]. Six months later, fixed appliances were removed and lower fixed retainer 3-3 was cemented along with upper and lower Hawley’s retainers [figures 13 14]. Cephalometric finding shows a good skeletal, dental and soft tissue relationship and improvement in the function and facial esthetics[Table 2, Figures15-17]. pre- and post-treatment cephalometrictracings Discussion This case report presents a combination of surgical and orthodontic therapy for an adult female patient with skeletal and dental class III malocclusion. The magnitude of the problem was so severe and lies outside the envelope of possible correction by orthodontics alone[xiv]. In growing patients, early treatment with maxillary expansion and protraction can result in straightening of profile after 6 months[xv]. It can also promote more favorable psychosocial development and greater compliance[xvi]. Delaying treatment can lead to development of posterior cross bite and the subsequent development of facial asymmetry[xvii].During adulthood, correction of the Class III malocclusion usually requires complex surgical procedures to achieve a good skeletal, dental and soft tissue relationship and improve the function and facial esthetics[xviii]. In this case, our objective were achieved. Compensated lower incisors were address by proclining them to the ideal position and inclination in pre-surgical orthodontic treatmentwhile in post-surgical orthodontic treatment teeth were brought into settledocclusion. Normal skeletal relationship was achieved byLe fort I osteotomyto advance the maxilla, Bilateral sagittal split osteotomy to correct mandibular asymmetry while maintaining the A-P position of the mandible and vertical reduction and advancementgenioplasty [i] [ii] [iii] [iv] [v] [vi] [vii] [viii] [ix] [x] [xi]. [xii]. [xiii] [xiv] [xv] [xvi] [xvii] [xviii]
Sunday, January 19, 2020
Dividend Policy Essay
Introduction Refer to Figure 1. Would you say that Montgomery’s policy up to now has been to pay a constant dividend, with occasional increases as the company grows? Montgomery has maintained the dividend policy of paying a regular dividend to their stakeholders. This steady dividend policy increases every time the firm produces. Since 200, the amount committed to paying dividends has grown each year, but particular emphasis has been placed on the figures that show dividends paid on every share. In 2000, they paid$1. 36, 2001 they paid $1.48, 2002 they paid $ 1.70, 2003 and 2004 the firm paid $1.76 each year, and in 2005 it paid dividend per share of $ 1.96 showing a steady increase over the six years. The top-level management has been confident about the constant or slight annual increase of the DPS because of the yearly rise in the overall number of shares every year since 2000 (Baker, 2009). Refer to Figure 2. What type of dividend policies would you say are being practiced by Montgomery’s competitors in the retailing industry? Do you think that any firms are following a residual policy? J.C. Penney 1999           2000  2001  2002  2003  2004  2005 EPS                $2.75           $2.94  $3.13  $2.91  $2.66  $3.53  $4.70 DPS                $0.92           $1.00  $1.08  $1.18  $1.18  $1.24  $1.48 Payout Ratio     33.5%        34.0%  34.5% 40.6% 44.4% 35.1% 31.5%  Dollar General 1999          2000  2001  2002  2003  2004  2005 EPS        $0.38        $0.61  $0.81  $1.10  $0.95  $0.23  $0.30 DPS         $0.09       $0.11  $0.13  $0.17  $0.20  $0.20  $0.20 Payout Ratio 23.7%  18%  16.1% 15.5% 21.1% 87.0% 66.7% Wal-Mart Stores 1999     2000  2001  2002  2003  2004  2005 EPS           $0.16     $0.23  $0.35  $0.48  $0.58  $0.80  $1.10 DPS            $0.02    $0.02  $0.04  $0.05  $0.07  $0.09  $0.12 Payout Ratio  12.5% 8.7%  11.4% 10.4% 12.1% 11.3% 10.9% The main competitors that Montgomery has been competing with are Wal- mart, J.C Penney, and Dollar General. The two firms are using the same policy used by Montgomery as they strive to increase their dividend per share each year. In 2004, despite Earnings per share, reducing by over 75% the dividend per share was held at $0.20. The dollar increased their profits by more than 17% despite the EPS decreasing by 14%. It is clear that a growth and stable dividend are critical factors considered by any growing retail company. We see that Wal-Mart, which is the biggest retail industry, also ignores emphasizing on capital growth as they go for stability in dividend and growth. The same case applies to J.C Penney, who maintains a stable dividend per share despite fluctuations in EPS. Montgomery has the highest average payout ratio compared to even Wal-Mart because of the long period they have been in the industry and with the same dividend policy, their DPS increase every year (Baker, 2009).  Question Two Calculate the expected return to the common stockholders under the firm’s present policy, given an expected dividend next year of $2.10 and a growth rate of 7.1 percent. Montgomery’s stock currently sells for $35.(Use the dividend growth model): Expected return (Ke) = D1 / P0 + g D1 = $2.10, g = 7.1%, P0 = $35, Ke, Expected return to stockholder = $2.10/$35 + 7.1% = 6+ 7.1 = 13.1% Assume that, if Don Jackson’s proposal were adopted, next year’s dividend would be zero, but earnings growth would rise to 14 percent. What will be the expected return to the stockholders (assuming the other factors are held constant)? Adopting Don’s suggestion will see the Stockholders earn no dividend at all, but the growth will increase by 14% with an expected return remaining the same as the growth rate. Expected Return to Stock holders= 0/$35+ 14% = 14%. Don’s suggestion will see the stakeholders enjoy an additional 0.9% on their expected return, thus the need to see the advantages of Don’s policy. Therefore, the firm cannot completely ignore the idea of changing to a residual dividend policy. On the other hand, the same stockholders will only make a 14% gain by selling their shares yet the current dividend policy earns them a 13.1%. Since there are no advantages enjoyed by capital gain as a result of existing legislation, then it could be wise for the Company to maintain the dividend policy they are using. This is because the shareholders could only benefit from residual dividend policy if the firm grew to 14% a fact that is only speculation. If the growth fall below13. 1% then the current system is still the best (Baker &Filbeck, 2012). Question three Don’s suggestion supports the fact that dividend and capital budget should be paid from the current year’s net income, a case that is untrue. This happens because the firm is being limited by the cash they are holding. The company’s balance in 2005 was $3,235,000 being the maximum amount that can be paid to the capital budget together with a dividend without having to outsource for funds or sell its existing assets. Paying dividends from retained earnings will force firms to sell their property since they are not hard cash (Baker &Filbeck, 2012). Question four Don says the cost of the outside financing is more expensive than the cost of internal financing, due to the flotation costs charged by investment bankers. Given the data you have, what would you say is the firm’s cost of internal equity financing?  The cost of borrowing from outside sources will only be higher because of costs incurred during flotation. Assume Montgomery can sell bonds priced to yield 13 percent. What is the firm’s after-tax cost of debt? (The tax rate is 25 percent. Bonds yield=13%. Therefore, after tax cost = 13%, multiply by (1-0.25) = 9.75%. Given the cost of debt and the cost of internal equity financing, why doesn’t Montgomery just borrow the total amount needed to fund the capital budget and the dividend as well. Borrowing money for capital budget and dividend will affect the debt-equity, causing it to be out of proportion as it will increase the cost of financing of debts as well as the costs of all other financial means  (Baker &Filbeck, 2012). Question five Do you go along with Clarence Autry’s comment that it is what the stockholders want that counts, not their total rate of return? Why or why not? Mr. Autry is against the residual dividend policy. This  means that the shareholders will not have a say or preference on the type of repayment they receive for investing in Montgomery as long as they earn the highest returns. If they are given the opportunity to choose, they will not go for that policy. There are no rules for determining whether shareholders can have a preference or how much they will benefit from it, thus making the issue very controversial. But the retailing industry as shown in the figures above for Wal-mart, J C Penney and dollar, they give shareholders a preference which is taking the current dividend paid rather than investing the cash in more attractive investments (Baker &Filbeck, 2012). Question six Barbara Reynolds suggests that, if cash is needed for the capital budget, a stock dividend could be substituted for a cash dividend. Do you agree? How do you think the stockholders would react? Regardless of their reaction, is the stock dividend an equivalent substitute for a cash dividend? As much as the firm is in a position to pay share dividend and not cash dividend, not all stockholders will be comfortable for some will feel that nothing was actually paid to them. This is so because the share dividend is just but a mere paper which the shareholders sign to create more shares. This could only become beneficial if it increased the shareholders total cash dividend which will go into the role of a stock dividend to conserve funds (Baker, 2009). Question seven After all is said and done, do you think the firm’s dividend policy matters? If so, what do you think Montgomery’s policy should be. Whether going for residual dividend policy or payment of a cash dividend, every financial analyst has his or her views. Many would argue that borrowing to invest rather than using the available money would increase costs due to flotation that are associated with borrowing from outside sources hence need to go for a residual dividend policy. On the other hand, Montgomery being an old firm that is used to the current dividend policy will be better off sticking to it. Consequently, leave residual dividend policy for new emerging retail companies (Baker, 2009). References Baker, K. (2009). ‘Dividends and Dividend policy.’eighth edition, Harvard Business School Press: New York. Baker, K. & Filbeck, G. (2012). ‘Alternative investments: Instruments, Performance, Benchmark and Strategies.’2nd edition, Harvard Business School Press: New York.       Â
Friday, January 10, 2020
How Did the Open Field System Work? Essay
When the community planted wheat year after year in a field, the nitrogen in the soil was depleted. Therefore, three-year rotations was introduced in order to retain the fertility of the soil. 3. Where and why did the agricultural revolution start? Include political, social and economic reasons. With the coming of the French Revolution, European peasants were able to improve their position by means of radical mass action. The agricultural revolution gradually spread throughout Europe beginning in the Low Countries, mainly the Dutch. The problem of soil exhaustion was solved using sophisticated patterns of crop rotation without using fallowing to increase land cultivation by 50 %. Economy was prospering because of trade and businesses. New ideas out of medieval age. 4. What was enclosure and was it a swindle of the poor by the rich? Enclosure is the term used to describe the need to enclose and consolidate scattered holdings into compact fenced-in fields in order to farm more effectively. It was not exactly a swindle of the poor by the rich because large investments were required and it imposed risks for the nobles as well. 5. What accounted for the increasing population of the 18th century? Increasing population in the 18th century was stimulated by commerce and overseas trade. 6. How was the grip of the deadly Bubonic Plague broken? Women were able to have more children because they married at a younger age due to new opportunities of employment. New improvements in water supply and sewage systems resulted in better public health and helped reduce diseases. Human beings became more successful in their efforts to safeguard supply of food in case of famine. 7. What was the putting out system? What were the advantages and disadvantages of this system for the merchant and for the worker? The putting-out system was used to describe the key features of the 18th century rural industry – for the new form of industrial production. Merchants advantages- large profits. Worker’s advantages- buy their own materials and work as independent producers before selling it to merchant.
Thursday, January 2, 2020
Alternative Energy Sources For A Call Center Based On...
Call Centre Report [Type the document subtitle] C M 9/29/2016 Table of Contents 1. Introduction 2 2. Description of current situation 2 3. Solar Systems 3 3.1 Active solar water heating systems 4 4. Biomass systems 5 Works Cited 6 Figure 1 - Roof mounted flat plate solar collectors and hot water tank. 3 1. Introduction With companies becoming more aware of how important it is to reduce their current environmental impact, alternative energy sources like solar and wind powered energy are becoming more prominent as eco-friendly alternatives to current unsustainable methods of power such as fossil fuels (BBC, n.d.) The purpose of this report is to identify the best suited alternative energy sources for a call center based on information the company has provided such as the area and space available, average wind speed, solar energy reach and average ground temperatures. 2. 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