Background: Mandibular first premolars exhibit significant anatomical variability, often leading to missed canals and endodontic failure. Although typically single-rooted, the presence of two roots is rare and poses a clinical challenge.

Case Presentation: A 63-year-old female patient presented with a decayed tooth in the lower right posterior region. Clinical and radiographic examination of tooth #44 revealed distal caries with periapical pathology. A diagnosis of irreversible pulpitis with chronic apical periodontitis was made.

Management: Root canal treatment was performed under rubber dam isolation. Two distinct canals were identified in buccal and lingual positions, confirming a two-rooted morphology. Cleaning, shaping, and obturation were completed successfully.