Fusion and gemination are not entirely uncommon dental anomalies that may also be named ‘double teeth’. This is due to their unusual presentation in a twin-like fashion. Teeth with these irregularities may appear clinically similar, presenting as large and bulbous in shape with unusual anatomy and fissure patterns. The exact aetiology of these anomalies is uncertain, but many potential local or systemic disturbances during the morphodifferentiation stage of odontogenesis have been considered. Gemination occurs rarely in the permanent dentition and even less frequently in the posterior region of the oral cavity. This report presents a case of a geminated mandibular second molar and discusses the importance of early recognition and diagnosis of such teeth so that adequate preventative care and treatment can be provided.