A comprehensive knowledge of complex root canal morphology and complete cleaning, shaping and obturated of root canal system are essential to achieve successful endodontic treatment. Maxillary first molars revealed a complex root canal morphology, this increased the complexity of treatment. Missed canals during root canal therapy resulting in lower success rate of endodontic treatment. This paper reported the case of a maxillary right first molar that presented three root canals in the mesiobuccal root and two root canals in the distobuccal root. Non-surgical root canal treatment of the case with the aid of dental operating microscope (DOM), ultrasonic instruments and cone beam computed tomography (CBCT) was demonstrated. This article also proposed a comprehensive review to provide a broader description of the canal configurations and its prevalence for the root canal system of the maxillary first molar, attempting to provide clinician to clarify the variations of the root canal system.