Treatment of combined endodontic-periodontal lesions is difficult to achieve successfully. It is still more complicated if accompanied by some developmental anomaly. The present article presents a case of a maxillary lateral incisor with a palatogingival groove and open apex, along with a draining sinus tract and severe bone loss. Teeth with such anomalies were often extracted in previous times. But now, due to development of newer materials such as MTA and bone graft materials along with better treatment techniques, these teeth can be preserved. In the present case, the groove was eliminated by saucerisation and using MTA to close an open apex for the creation of an apical plug. The patient was asymptomatic and radiographic healing was observed after a period of 1 year. Schlagwörter: endodontic-periodontal lesions, MTA, open apex, palatogingival groove