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Hemisection, a surgical procedure involving the removal of one root and its associated coronal portion from a multi-rooted tooth, is a complex treatment option that aims to salvage a severely compromised tooth while maintaining its functionality and overall oral health. A middle-aged female patient presented with pain and tooth mobility in the lower jaw for the past 2 months. Initially, root canal treatment was done to treat symptoms of symptomatic irreversible pulpitis and apical periodontitis. However, considering the poor prognosis and restorability of the tooth, surgical flap reflection was done along with the procedure of hemisection. The successful management of a mandibular molar with advanced periodontal and endodontic pathology through hemisection is reflected in this case. The clinical presentation, diagnostic assessments, treatment planning, surgical procedure and postoperative outcomes are detailed, along with a comprehensive review of relevant literature on hemisection.