Background: Endo-periodontal lesions (EPL) present considerable diagnostic and therapeutic challenges. Hemisection, when appropriately indicated, serves as a conservative alternative to extraction in multirooted teeth. Case Presentation: This report presents two separate cases in which mandibular molars exhibit EPL with localized root damage. Following comprehensive endodontic and periodontal evaluation, the non-salvageable distal root was resected, and the remaining mesial root was preserved. Treatment included nonsurgical root canal therapy, full-thickness flap surgery, debridement, hemisection and socket preservation using demineralized freeze-dried bone allograft (DFDBA), platelet-rich fibrin (PRF), and a collagen membrane. Both cases were rehabilitated with a fixed partial denture. 12-month postoperative follow-up of both cases demonstrated successful clinical and radiographic outcomes, including stable periodontal parameters and restored function. Conclusion: Hemisection remains a viable option for preserving function and natural dentition in selected cases of EPL with localized root damage.