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Background and Objectives: Controversy exists regarding the need for a space maintainer after early unilateral loss of a primary first molar. This study aimed to assess the need for a space maintainer after unilateral loss of a primary first molar in the early mixed dentition period. Materials and Methods. In this cross-sectional study, fifty children between 6 and 8 years who had lost a primary first molar unilaterally later than 6 months ago were randomly selected. Midline deviation, molar and canine relationships at both sides, facial growth pattern, and the amount of space loss were all assessed. Data were analyzed using SPSS version 25 via the one-sample t-test, paired t-test, and linear regression (alpha = 0.05). Results. The mean amount of space loss was 1.36 ± 0.78 mm (1.32 mm in the maxilla and 1.40 mm in the mandible). Time since tooth extraction and facial pattern had significant correlations with space loss P<0.05. Conclusion. In this particular age group, it is imperative to precisely assess the related factors such as the facial pattern and time since tooth extraction to decide about the placement of a space maintainer for a prematurely lost primary first molar.