Employing minimally invasive operative techniques to manage compromised first permanent molars is discussed as a treatment regimen to achieve a favourable medium-to long-term prognosis in modern paediatric dental management. It is known that patient cooperation, stage of dental development and eruption state, as well as chronological age and severity of tissue breakdown of the compromised tooth have an influence on the prognosis of treatment. CPD/Clinical Relevance: Understanding the various prognostic factors involving compromised first permanent molar teeth is essential if optimum treatment is to be provided.