ABSTRACT
INTRODUCTION: The complexity of the root canal system of maxillary molars presents a constant challenge in the diagnosis and treatment of these teeth. This case report describes the importance of a surgical operating microscope and cone-beam computed tomographic (CBCT) imaging. METHODS: Root canal treatment of a left maxillary first molar with 3 roots and 7 canals was successfully performed. Seven canals were identified with the help of a surgical operating microscope and CBCT imaging. CBCT images also confirmed the 3 roots and 7 canals in the right maxillary first molar. RESULTS: CBCT images confirmed a type IV canal pattern in the distal and palatal root, whereas the mesial root had a type VIII canal pattern. CONCLUSIONS: The use of a surgical operating microscope and CBCT imaging helps the clinician to diagnose unusual anatomy of a tooth and facilitate successful endodontic treatment.