Having knowledge and comprehension of the existence of an extra root and atypical root canal structure is crucial, as it directly impacts the effectiveness of endodontic treatment. Acquiring a comprehensive understanding of the fundamental structure of root canals and their potential deviations is crucial for the successful execution of endodontic procedures. The anatomical features of permanent maxillary molars are often characterized by the presence of three roots, consisting of one palatal root and two buccal roots. The occurrence of two palatal roots is infrequent; yet, there have been a few documented instances of a fourth root canal in the maxillary first molar, indicating the presence of additional canals in the palatal root of maxillary molars. This case report presents the treatment of a maxillary first molar with four root canals, specifically the mesiobuccal, the distobuccal, and two palatal canals. When performing root canal therapy on teeth with anatomical anomalies, it is crucial to develop precise treatment procedures. Understanding the anatomical changes that occur in the palatal roots of maxillary first molars can enhance the efficacy of root canal treatments.