Out of the box thinking
I posted about this case a week ago. Her periodontist called #9 hopeless and was all set to extract it and do a bone graft. She wants to keep her tooth as long as possible. She was fully informed of all possible consequences and wanted to proceed with a crown. When the preparation was completed, two red spots appeared on the labial axial wall. There was no bleeding noted. Initially Theracal was placed over the spots but discretion seemed to be the best approach and Endodontic therapy was done to prevent the almost certain onset of post operative pain. This patient is not a happy person. The first time I have seen her smile was when she looked at her tooth in a mirror. We'll see how long this lasts. The extraction and bone graft can always be done when this fails. This is not a Bill Marais quality job, but it is a huge improvement over the pre operative situation. The software had similar issues with this tooth as it has when proposing an implant crown in an edentulous space. But she has a low lip line. This was Biocopy from a waxup. Not the best stain and glaze job. The assistant chose the wrong Programat CS setting and three bakes were necessary but the patient is thrilled. 
I had to reread that a few times-- "she's not a happy person", which I take now as generally, but is VERY happy with your work--- and she SHOULD be.. nicely done!
Mark
Great job Dr. Chuck.
Curious if there is a pulp "blush" in the prep picture. Im sure the reduction was necessary for repositioning. Again, excellent job!
That is a pulp blush. The photo shows the Theracal I initially placed over the pulp exposure. There was no bleeding so I assumed the basement membrane was intact. The pre-op radiograph showed the pulp receeded below the CEJ. That was obviously not the case. I will be out of the office for a week so I decided to do the endo rather than risk having her hurting and trying to find a dentist who would see her.
Tough to deal with the angulation of the other central, but the most important thing is the generally unhappy person "is thrilled."
Good job!
If you can turn that sad frown upside down...that is a good thing! Congrats on helping someone feel much better about themselves.
@Professor: Great to see you back in the saddle and posting! Woohoo!
TK,
The bone support for this tooth is down to about 25% of normal, and she is plugged in to a local periodontist who I refer to as "Her Royal Highness." She was not happy that her treatment plan was not accepted. I am certain that any subepithelial dermal grafting would be done by the perio. I can definitely make the suggestion.
