Objective To analyze the effect of oral restoration combined with orthodontic treatment on masticatory function and dental aesthetics in patients with congenital missing teeth. Methods A total of 62 patients with congenital missing teeth admitted to the outpatient department of our hospital from December 2021 to December 2022 were selected as the research subjects. According to the random number table method, they were divided into the control group and the observation group, with 31 patients in each group. The control group received oral restoration, and the observation group received oral restoration combined with orthodontic treatment. The clinical efficacy, masticatory function, dental aesthetics and adverse reactions were compared between the two groups. Results The total effective rate of treatment in the observation group was 93.55%, which was higher than 32.26% in the control group (P <0.05). The scores of occlusal ability, dental stability and food occlusion assessment in the observation group were all higher than those in the control group (P <0.05). The scores of facial aesthetics coordination, tooth morphology and color in the observation group were better than those in the control group (P <0.05). The incidence of adverse reactions in the observation group (16.13%) was lower than that in the control group (67.74%) (P <0.05). Conclusion Oral restoration combined with orthodontic treatment has a better treatment effect on congenital missing teeth. It can not only improve the dental aesthetics and masticatory function of patients with congenital missing teeth to a certain extent, but also reduce the incidence of adverse reactions, which is worthy of application.