Objective To investigate the efficacy and safety of surgical guided eruption combined with orthodontics in patients with impacted upper anterior teeth. Methods A total of 46 patients with impacted upper anterior teeth in our hospital from June 2021 to March 2023 were randomly divided into control group and experimental group, with 23 patients in each group. The control group was treated with surgical guided eruption surgery, and the experimental group was treated with surgical guided eruption surgery combined with orthodontic treatment. The alveolar bone density, treatment effect and complications were compared between the two groups. Results The alveolar bone density of the experimental group was higher than that of the control group at 5 and 10 days after operation, and the difference was statistically significant (P <0.05). The total effective rate of treatment in the experimental group was 95.65%, which was higher than 73.91% in the control group, and the difference was statistically significant (P <0.05). The incidence of complications in the experimental group was 4.35%, which was lower than 30.43% in the control group, and the difference was statistically significant (P <0.05). Conclusion The efficacy and safety of surgical guided eruption surgery combined with orthodontic treatment for impacted upper anterior teeth are high. It can effectively improve alveolar bone density, improve oral function and improve appearance.