Surgical Extraction of a Rare Four-rooted Permanent Mandibular First Molar: A Case Report

Background:The mandibular first molar is known for its anatomical variability, most commonly exhibiting two roots.The presence of four roots is exceedingly rare and can pose significant challenges during dental procedures such as extraction.Case presentation: This report describes the surgical extraction of a four-rooted permanent mandibular first molar in a 17-year-old male.Clinical and intraoperative findings revealed an unusual root configuration consisting of two mesial and two distal roots.Due to the absence of radiographic imaging, the diagnosis was made intraoperatively, requiring a modified surgical approach.