Objective To observe the clinical effect of minimally invasive complex tooth extraction combined with gingivoplasty on periodontal soft tissue aesthetic repair. Methods Eighty patients with complex tooth extraction indications and periodontal soft tissue aesthetic improvement needs were included in this study. All patients received standardized treatment in our hospital from January 2021 to January 2025. They were randomly divided into two groups, 40 cases in each group. The control group was treated with conventional complex tooth extraction combined with basic periodontal wound treatment, while the observation group was treated with minimally invasive complex tooth extraction combined with gingivoplasty. The operation related indicators, periodontal related indicators and aesthetic satisfaction of the two groups were compared. Results the operation time of the observation group was shorter than that of the control group, the amount of bleeding during operation was less, and the pain score 24 hours after operation was lower (P<0.05); At 3 and 6 months after operation, the periodontal probing depth and gingival recession in the observation group were lower than those in the control group, and the gingival papilla index was higher than that in the control group (P<0.05); The aesthetic satisfaction of the observation group was higher than that of the control group (P<0.05). Conclusion the development of minimally invasive complex tooth extraction combined with gingivoplasty has little damage to the periodontal tissue of patients, can stabilize the gingival tissue morphology, alleviate the problems of gingival papilla atrophy and gingival recession, and improve the aesthetic repair effect of periodontal soft tissue of patients, which has high clinical application value.