Endodontic management of a mandibular first molar with four mesial root canals

This case report documents the successful endodontic retreatment of a mandibular first molar exhibiting four mesial root canals in a 20-year-old male patient—an exceptionally rare anatomical configuration. Following the extraction of the perforated distal root, careful clinical exploration revealed two supplementary canals demonstrating apical convergence with the primary canals. The treatment protocol incorporated ultrasonically activated irrigation, precision rotary instrumentation, and warm vertical compaction obturation with bioceramic sealer. This case underscores the critical importance of thorough anatomical exploration in complex root canal systems.