Dens evaginatus is a disturbance in tooth formation that appears clinically as an accessory occlusal tuberculated cusp composed of enamel and dentin, usually enclosing pulp tissue. The tubercle often fractures or is worn away, with subsequent pulp exposure leading to pulpal inflammation, necrosis, and periapical inflammation. When this happens to an immature tooth, diagnosis may be complicated by the similarity in radiographic appearance of the periapical lesion and the dental follicle. The management of such teeth may be complicated because of their immaturity. A case report of multiple abraded dens evaginatus with pulp necrosis is presented that illustrates 1) the difficulty of diagnosing otherwise apparently healthy teeth associated with periapical lesions and sinus tracts, and 2) their management and treatment complications including recurrent infections and root fractures.