Dens evaginatus is a developmental anomaly of tooth characterized by presence of a tubercle like projection from the tooth surface most commonly giving the form of a cusp. It comes under significant clinical consideration because of difficulty in diagnosis and having the chance of pulpal involvement after wearing off. The further consequences of a broken dens evaginatus can be pulp necrosis followed by formation of periapical pathology. There are several treatment options for this clinical entity but the treatment modality depends on the tubercle integrity, status of pulpal health and stage of root development of the involved tooth.
Here a case of broken dens evaginatus is reported with a large periapical lesion on both sides of mandibular first premolar having a wide open apex. For treatment, we opted the process of revascularization because it supports the physiological regeneration of periapical tissue and even helps in root completion.
At two years postoperative recall examination, the involved tooth was found completely asymptomatic and radiographically the periapical lesion was fond to be healed. Radiographic confirmation was also evident for root completion and thickening of the lateral dentinal wall.
In this present case, we have discussed a case of Dens evaginatus that itself has some diagnostic dilemma along with its most physiologic form of a treatment option that has ultimately resulted in an excellent prognosis of the case.
Keywords: Dens evaginatus, Periapical lesion, Premolar, Revascularization.