Objective To analyze the effect of orthodontics combined with oral restoration on periodontal indexes and aesthetic degree in patients with congenital missing teeth. Methods A total of 78 patients with congenital missing teeth admitted to our hospital from June 2023 to December 2024 were selected as the research subjects, and they were divided into the control group and the observation group by the random number table method, with 39 patients in each group. The control group received oral restoration treatment, and the observation group received orthodontics combined with oral restoration treatment. The clinical efficacy, dental aesthetic degree, periodontal indexes and adverse reactions were compared between the two groups. Results The total effective rate of treatment in the observation group (97.44%) was higher than that in the control group (82.05%) (P <0.05). After treatment, the scores of PES and WES in the observation group were higher than those in the control group (P <0.05). After treatment, the scores of SBI, PLI and TM in the observation group were lower than those in the control group (P <0.05). The incidence of adverse reactions in the observation group (2.56%) was lower than that in the control group (17.95%) (P <0.05). Conclusion Orthodontics combined with oral restoration can effectively improve the treatment effect in patients with congenital missing teeth, improve their periodontal status, enhance the dental aesthetic degree, and has fewer adverse reactions, with higher treatment safety.