Disparities in quantity and root canals are perhaps a few of the most commonly portrayed anomalies in studies. The occurrence of 2 canals may be deemed usual but racial disparities in the root canal anatomy of premolars have been recognized. The composition of a maxillary premolar with 3 canals: palatal, distobuccal and mesio buccal is comparable to the neighboring maxillary molars, and they are occasionally described to as small molars. A 22 years old male patient of Saudi descent presented at dental clinics of Riyadh Elm University. No medical history was reported by the patient, and he reported no use of medications or drugs. His chief dental problem was the instinctive pain around the upper left premolar #24 for a week. Intraoral examination and radiographic interpretation discovered deep disto-occlusal destruction by caries. The maxillary first premolars are amid the utmost problematic teeth to be managed endodontically for numerous causes: the quantity of roots, the quantity of canals, the direction and longitudinal depressions of the roots, the several pulp cavity formations, and also the problems in envisioning the apical limit by x-rays so it is significant for every dentist to be mindful of the variations in form and number of roots and root canals are expected to happen, and occasionally in a rare form, as in the premolar with 3 canals and 3 roots. Understanding such variations and pay more attention to the radiographs will help in diagnosing and treating endodontic cases so such alterations do not affect prognosis.
