Abstract
Background: The aim of this case was to understand and treat the intricate root canal anatomy observed in complex maxillary first premolars, particularly those exhibiting three root canals, emphasizing the significance of understanding root canal morphological variations in their treatment. Conclusions: This case reported the methods of treating three-root canal maxillary first premolars, including warm vertical compression technique, root canal microsurgery, and the application of rubber dam. The utilization of dental operating microscopes, various surgical strategies, and key assessments of X-rays and cone beam computed tomography (CBCT) scans were all essential steps for achieving accurate and safe root canal therapy.