The primary goal of root canal therapy is to locate all canals, achieve thorough debridement, and ensure a three-dimensional obturation of the canal system. Understanding the internal anatomy of the root canal structure is a critical aspect of successful endodontic treatment. Typically, the mandibular first molars present with two roots and 3 or 4 canals; however, the occurrence of additional canals, particularly the middle mesial canal, has been documented in various studies. This case report highlights the role of CBCT in the diagnosis and management of a mandibular 1st molar with an unusual presentation of 7 root canals. A dental operating microscope was used for clinical identification of the canals, and the findings were confirmed by CBCT imaging. This case emphasizes the importance of recognizing anatomical changes and the potential for additional canals during endodontic treatment. A comprehensive diagnosis is essential to ensure the long-term success of the procedure.
