Background: The mandibular second premolar is known for its unpredictable internal anatomy. The simultaneous occurrence of three canals, a C-shaped configuration, and hypertaurodontism—an "anatomical trifecta"—is exceptionally rare and presents significant endodontic challenges.

​Case Description: A 15-year-old female presented with symptomatic apical periodontitis in tooth 44. Initial access revealed a vertically elongated pulp chamber and a C2 (semicolon-shaped) canal configuration. Integrated 3D mapping via Cone Beam Computed Tomography (CBCT) and real-time visualization with a Dental Operating Microscope (DOM) were utilized to navigate the complex isthmus and avoid strip perforations in danger zones.