Objective To explore the effect of orthodontics combined with periodontal tissue regeneration surgery on aesthetic cosmetic effect in patients with periodontitis. Methods A total of 78 patients with periodontitis admitted to Jiangyin Bege Dental Clinic from October 2020 to October 2023 were selected as the research subjects. According to the random number table method, they were divided into the observation group and the control group, with 39 patients in each group. The control group was treated with periodontal tissue regeneration surgery, and the observation group was treated with orthodontics combined with periodontal tissue regeneration surgery. The clinical efficacy, smile aesthetic indexes, periodontal status and adverse reactions were compared between the two groups. Results Compared with 82.05% of the total effective rate of the control group, the total clinical effective rate of the observation group was higher, reaching 97.44% (P <0.05). After treatment, the smile curve, gingival exposure, canine space and buccal space ratio of the observation group were lower than those of the control group (P <0.05). After treatment, the scores of PD, AL and GI in the observation group were lower than those in the control group (P <0.05). Compared with 20.51% of the incidence of adverse reactions in the control group, the incidence of adverse reactions in the observation group was lower, only 2.56% (P <0.05). Conclusion The combination of orthodontics and periodontal tissue regeneration surgery can enhance the oral cosmetic effect in patients with periodontitis, improve the periodontal condition, inhibit the level of inflammatory factors, and reduce the incidence of adverse reactions, which has high clinical application value.