The endodontic treatment of a tooth with radix entomolaris can present significant challenges due to the presence of root curvature. The present report describes the endodontic treatment of a permanent mandibular first molar with type II radix entomolaris and separation of endodontic file in the root canal followed by its retrieval using the trephining technique. A 38 years old female patient visited the Department of Operative Dentistry at the Dow University of Health Sciences with complain of spontaneous and lingering pain and food impaction in tooth #46 since six months. On intraoral examination, tooth #46 had class II cavity. On periapical radiograph, an accessory root was observed. Endodontic treatment of the tooth was initiated. During shaping of the accessory canal, SX separated. The separated file was bypassed and successful retrieval was performed using the trephining technique. Endodontic treatment of the tooth was completed. The tooth was found to be asymptomatic in the followup visits and the patient was referred for a full coverage crown.
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