Objective To investigate the effect of orthodontics combined with nanocomposite resin restoration on pulp vitality and masticatory efffciency in patients with anterior tooth defect and malocclusion. Methods A total of 86 patients with anterior tooth defect and malocclusion admitted to Suzhou Stomatological Hospital from January 2023 to October 2025 were selected. According to the random number table method, they were divided into the control group (n=43) and the research group (n=43). Both groups received orthodontics. The control group received composite resin restoration, and the study group received nanocomposite resin restoration. The pulp vitality, masticatory efffciency, periodontal indicators, dental aesthetics and oral health impact were compared between the two groups. Results After treatment, the pulp vitality and masticatory efffciency of the study group were higher than those of the control group (P<0.05). After treatment, the PD and AL in the study group were lower than those in the control group (P<0.05). After treatment, the AI score of the study group was (2.18±0.22)points, which was lower than (2.82±0.24)points of the control group (P<0.05). After treatment, the OHIP-14 score of the study group was lower than that of the control group (P<0.05). Conclusion Orthodontics combined with nanocomposite resin restoration can effectively improve the pulp vitality and masticatory efffciency of patients with anterior tooth defect and malocclusion, optimize periodontal indicators, and enhance dental aesthetics, while reducing the adverse impact on patients' oral health.