Periodontal endodontal lesions present a difficult diagnostic and treatment challenge to the clinician and treatment often requires a combined therapeutic effort. Both endodontal and periodontal surgical procedures may be indicated for access and treatment of these lesions. This case report presents an early onset periodontitis patient with bilateral periodontal-endodontal lesions on mandibular first molars. Treatment included apical surgery followed by repeated scaling and root planing on one tooth and root canal obturation followed by a periodontal bone grafting procedure on the other. Both procedures resulted in clinical attachment gain as well as radiographic evidence of alveolar bone gain. This case report once again demonstrates that proper diagnosis followed by removal of etiologic factors and nonsurgical therapy or periodontal regenerative procedures can restore health and function in cases of severe attachment loss.