<![CDATA[Hemisection is a conservative dental procedure performed to preserve a compromised tooth by removing the affected root while maintaining the remaining tooth structure and function. This case report describes the management of a 41-year-old female with pulp necrosis, periapical lesions, bifurcation perforation, and periodontitis involving the mandibular left first molar. The patient presented with recurrent pain and failure of a tooth-colored restoration placed two years earlier. Clinical and radiographic examinations revealed radiolucent lesions in the mesial and distal periapical regions, bifurcation perforation, and periodontal involvement. Root canal treatment was performed, followed by hemisection of the affected root. The remaining tooth was restored using a prefabricated fiber post and a zirconia crown. At follow-up, the patient was asymptomatic, with satisfactory restoration margins and proximal contact. Radiographic evaluation demonstrated reduced radiolucency and evidence of bone formation in the extraction socket. This case suggests that hemisection combined with endodontic treatment and restoration using a prefabricated fiber post and zirconia crown is an effective treatment option for preserving mandibular molars with pulp necrosis, periapical lesions, bifurcation perforation, and periodontitis.]]>
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