Morphologic variations of dental hard tissue should be recognized and considered during restorative procedures. Overlooking anomalies increases the potential for clinical complications. Amalgam was used erroneously in a patient when the presence of a paramolar structure was overlooked. The clinical complications that resulted from overlooking the anomaly led to restorative, endodontic, and periodontal failures. The present report describes the use of conservative endodontics and a cast restoration, taking into account the rpesence of the paramolar structure, to correct the case.