Objective To analyze the application effect of cone-beam CT in orthodontics combined with proffle aesthetics optimization. Methods A total of 62 patients who received orthodontics treatment combined with profile aesthetics optimization in the Department of Stomatology, Nanchong Central Hospital from August 2022 to August 2023 were selected. 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 was examined with conventional X-ray, and the observation group was examined with cone-beam CT. The treatment effect, satisfaction, periodontal status and quality of life were compared between the two groups. Results The total effective rate of the observation group (96.77%) was higher than that of the control group (80.65%) (P<0.05). The satisfaction rate of the observation group (93.55%) was higher than that of the control group (74.19%) (P<0.05). The anterior overjet, anterior overbite and periodontal pocket depth in the observation group were better than those in the control group (P<0.05). There was no statistically significant difference in alveolar bone height between the two groups (P>0.05). The scores of all dimensions of quality of life in the observation group were higher than those in the control group (P<0.05). Conclusion The application of cone-beam CT in orthodontics combined with proffle aesthetics optimization has a deffnite effect. It can improve the treatment effect, periodontal status and quality of life of patients, and is conducive to enhancing patient satisfaction. It is worthy of clinical application.