Aim: Mucosal fenestrations affecting permanent teeth are clinically challenging because they require a more complex approach. The objective of this case report was to describe a treatment modality used to manage an apical fenestration placed on the left mandibular central incisor root. Case Report: The case report describes the management of a patient with mucosal fenestration of root apex. Mucosal fenestration of root apex was treated by a combination of root canal treatment and surgery. Root-end resection was performed to bring the root apex within the alveolus before root-end filling and packing of the bony defects with platelet rich fibrin. The dehiscence of the buccal labial plate was managed by placement of a barrier membrane. The edges of the soft tissue defect was then deepithelialized, approximated and sutured. Discussion: Various treatment modalities advocated in the literature for the management of mucosal fenestration include- root canal treatment and root-end resection, blind root surface instrumentation and mouth rinsing with chlorhexidine, full thickness mucogingival flap with primary or secondary healing, pedicle flap operations, epithelialized and non-epithelialized grafting procedures for root coverage and full thickness mucogingival flaps with guided tissue regeneration and bone grafting. Conclusion: The endodontic and periodontal surgical techniques used in the management of alveolar or mucosal fenestrations alone are unremarkable but combining them can give optimum outcome.__ampersandsignnbsp;