Sir, working in the radiology department of a dental hospital, we recently encountered a case of an upper central incisor with a tubercular shaped projection from the palatal surface, in keeping with dens evaginatus: a developmental anomaly with a prevalence of 1-4%. It presents as an accessory cusp consisting of enamel, dentine and pulp. Common sites are the occlusal surfaces of premolars and the lingual surfaces of anterior teeth.1

There is a risk of fracture from occlusal trauma, resulting in exposure of the pulp and devitalisation of the tooth. Early detection and treatment is therefore important with options often including enameloplasty.2 This is dependent on the presence, position and extension of pulp tissue into the accessory cusp. Conventional images are not capable of identifying this with any level of accuracy. CBCT is an accessible, reliable and relatively low dose 3D modality, used here to show a significantly sized additional palatal cusp with a prominent pulp projection from the pulp of the 11 (Fig. 1).3

Fig. 1
figure 1

CBCT image showing dens evaginatus 11 with a pulpal projection into the accessory cusp

Full size image

3D imaging provides accurate assessment of a simple but important developmental anomaly with low radiation burden. It is essential that users of CBCT are adequately trained to interpret these images.