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Endodontic treatment of fused teeth needs special care and attention due to its complex anatomy. The aim of this article is to highlight the problems encountered and the strategy in treating such cases. We report a case of unilateral fusion of the left mandibular central incisor and lateral incisor, with a single pulp chamber. The single pulp chamber separates into two root canals and a large communication exists at the apical third of the root canals. This is the first time fused teeth with a large communication is reported. CBCT analysis was effective in confirming the morphological aberrations and aided in accurate planning and treatment. Chemomechanical preparation with manual dynamic irrigation coupled with passive ultrasonic activation of the irrigant and obturation with thermoplasticised gutta percha helped in successful outcome of the case.