Objective To evaluate the clinical effect of orthodontics combined with surgical guided eruption surgery in patients with impacted anterior teeth and its effect on the incidence of adverse reactions. Methods A total of 86 patients with impacted upper anterior teeth treated in our hospital from June 2020 to November 2023 were randomly divided into control group and observation group, with 43 patients in each group. The control group was treated with surgical guided eruption surgery. The observation group was treated with orthodontics combined with surgical guided eruption surgery. The clinical efficacy, adverse reactions, masticatory efficiency, gingival breaking time, tooth aesthetics and pain degree were compared between the two groups. Results The total treatment effective rate of the observation group was 95.35%, which was higher than 79.07% of the control group (P <0.05). The incidence of adverse reactions in the observation group was 2.33%, which was lower than 18.60% in the control group (P <0.05). The masticatory efficiency of the observation group was higher than that of the control group (P <0.05). The gingival breaking time of the observation group was shorter than that of the control group (P <0.05). After treatment, the PES score of the observation group was higher than that of the control group (P <0.05). After treatment, the VAS score of the observation group was lower than that of the control group (P <0.05). Conclusion Orthodontics combined with surgical guided eruption surgery can shorten the gingival rupture time of patients with impacted upper anterior teeth, improve masticatory efficiency, relieve tooth pain, improve overall efficacy and aesthetic effect, and have less adverse reactions, which has clinical reference significance.