The literature extensively documents root anomalies in human permanent premolars and molars, presenting a challenge for successful endodontic treatment. The variations in mandibular first molars specifically involve the number of roots, root canals, and morphology. The additional roots, radix entomolaris, and radix paramolaris, are located lingually and buccally, respectively. The presence of an extra root can alter the route of treatment, especially when endodontic treatment is necessary, and requires knowledge of common anatomical characteristics and their possible variations. An early understanding of tooth morphology is essential for meticulous handling. Although the permanent mandibular first molar typically has two roots, mesial and distal, the presence of an extra root canal could cause infection and endodontic failure if left undiagnosed or improperly prepared during root canal preparation, leading to abscess formation. Identification of an extra root is challenging with periapical radiographic methods due to the superimposition of two roots. However, the significance of this endodontic concern has been highlighted through two documented cases that required endodontic treatment. Therefore, an accurate diagnosis, identification, and treatment of these variations require adequate knowledge of root and root canal anatomy and configurations to improve outcomes. Additionally, due to missed canals, mandibular first molars have a lower success rate following root canal treatment. Awareness of extra roots facilitates diagnosis and improves the overall prognosis for endodontic retreatment of an extra root can minimize complications related to exodontia, such as root breakage