The permanent first molars play an important role in the dentition. In cases in which these teeth have a poor prognosis, tooth extraction and closure of space or use of space with orthodontic treatment are considered. In the present study, the treatment plan for the first permanent molar with a poor prognosis is described and qualitative results are reported. The data we used in our review were searched from articles published between 2000 to 2020 and using first permanent molar, poor prognosis, and children as keywords and after the abstract screening, full-text of 13 clinical related studies were reviewed. Ideal conditions for permanent first molar extraction include the presence of other teeth, class I occlusion with buccal crowding, and children aged 8.5 to 10 years. It is important to consider the balancing and compensating extraction of the first permanent molars with a poor prognosis to prevent midline shift and overgrowth of the opposite tooth.