Objective To investigate the clinical efficacy of orthodontic combined with restoration in patients with dentition defect and small teeth and its effect on tooth alignment, occlusal relationship and gingival condition. Methods A total of 100 patients with dentition defect and small teeth who were treated in the Department of Stomatology of our hospital from January 2020 to December 2021 were randomly divided into control group and observation group, with 50 patients in each group. The control group was treated with orthodontic treatment alone, and the observation group was treated with orthodontic with restoration treatment. The treatment effect, satisfaction and complications rates of the two groups were compared. Results The scores of tooth arrangement uniformity, occlusal relationship and gingival condition in the observation group were better than those in the control group, and the differences were statistically significant (P <0.05). The treatment effect, aesthetics and comfort satisfaction scores of the observation group were higher than those of the control group, and the differences were statistically significant (P <0.05). The incidence of complications in the observation group was 4.00%, which was lower than 16.00% in the control group, and the difference was statistically significant (P <0.05). Conclusion Orthodontic combined with restoration treatment is effective in patients with dentition defect and small teeth, which can improve patient satisfaction and reduce the risk of complications. It is worthy of clinical application.