Anomaly like central cusp is accessory cusp which is similar to Dens Evaginatus (DE) in premolars. Such accessory occlusal/central cusps are rarely being reported in mandibular molars. The presence of these structures can be a cause of concern when they interfere with occlusion, get fractured or pulp is exposed. This report presents an unusual case of 21-year-old male patient with bilateral accessory cusp in permanent mandibular second molars, the left with Occlusal central cusp (7-cusp anatomy) and the right with a prominent expression of tuberculum sextum (5-cusp anatomy). The patient reported with sensitivity on lower left second molar. Radiograph did not reveal any pulpal extension in both the teeth. Buccal caries on left second molar was restored with composite resin and the accessory cusp was incrementally grinded. The patient reported on follow-up visit after 6 months and was asymptomatic. Early identification of supernumery occlusal central cusp and proper treatment can avoid pulpal complications.