Objective To explore the effect of minimally invasive extraction in the treatment of complicated mandibular impacted teeth. Methods A total of 80 patients with complicated mandibular impacted teeth admitted to Panzhou People's Hospital from January 2024 to May 2025 were selected. According to the random number table method, they were divided into the control group and the observation group, with 40 patients in each group. The control group was treated with conventional tooth extraction, and the observation group was treated with minimally invasive extraction. The treatment effect, surgery-related indicators and aesthetic scores were compared between the two groups. Results The total effective rate of the observation group (95.00%) was higher than that of the control group (75.00%) (P <0.05). The operation time, intraoperative blood loss, degree of facial swelling and degree of mouth opening limitation in the observation group were better than those in the control group (P <0.05). The scores of WES and PES in the observation group at 3 months after surgery were higher than those in the control group (P <0.05). Conclusion Minimally invasive extraction has a definite effect in the treatment of complicated mandibular impacted teeth. It can reduce intraoperative blood loss, alleviate facial swelling and mouth opening limitation, and the operation time is short, which is conducive to improving oral aesthetic scores.