Objective To explore the effect of combined orthodontic and restorative treatment for malocclusion with first molar loss. Methods A retrospective study was conducted on 40 patients with malocclusion and first molar loss in Miaoshan Community Health Service Center, Jiangxia Economic Development Zone, Wuhan City, Hubei Province from February 2018 to February 2023. According to the treatment methods, they were divided into two groups: orthodontic combined repair treatment group (combined treatment group) and single repair treatment group (single treatment group), with 20 patients in each group. The treatment effects, soft scale indexes, plaque adhesion indexes, fixation status, quality of life, oral health status, oral improvement, aesthetic compliance, and satisfaction between two groups were statistically analyzed. Results The success rate of treatment in the combined treatment group was 100.00%, which was higher than 85.00% in the single treatment group (P<0.05). The soft scale index and plaque adhesion index of the combined treatment group were lower than those of the single treatment group (P<0.05), while the scores of fixation, quality of life, tooth fixation, facial aesthetics, eating and chewing, assisted vocalization, comfort, aesthetics, eating function, and language function were higher than those of the single treatment group (P<0.05). The aesthetic compliance rate of 95.00% in the combined treatment group, which was higher than 80.00% in the single treatment group (P<0.05). The satisfaction rate of 95.00% in the combined treatment group, which was higher than 75.00% in the single treatment group (P<0.05). Conclusion The combined orthodontic and restorative treatment for malocclusion with first molar loss is more effective than individual restorative treatment, it can better improve the success rate of treatment, reduce the soft scale index and plaque adhesion index, improve fixation and quality of life, improve oral health and oral improvement, and increase the rate of aesthetic compliance and satisfaction.