Among developmental anomalies of tooth shape, fusion and gemination are comparatively common. Developed with different etiologies, both fusion and gemination show similar clinical features. Therefore, many clinicians have difficulty diagnosing those morpho-anatomic anomalies. The purpose of this study is to report malformed right maxillary first molar in a 20-year-old female. With the aid of computed tomography (CT), the tooth was diagnosed as fusion with supernumerary tooth and dental caries lesion was detected. After performing direct pulp capping, the tooth was permanently restored with microhybrid composite resin using direct method to alter union groove into smooth surface for improving oral hygiene management. Until 6 months of follow-up visits, patient's chief complaint was resolved and tooth is still vital. In conclusion, identifying exact anatomy, conservative treatment and improving oral hygiene are essential in managing unusual morphologic anomalies of tooth.