Objective To explore the clinical effect of maxillary protraction orthodontics combined with soft-tissue smile aesthetic reconstruction in children with maxillary retrusion and anterior crossbite. Methods A total of 64 children diagnosed with maxillary retrusion and anterior crossbite admitted to Zhongning County People’s Hospital from March 2024 to December 2025 were selected, and they were divided into the control group and the experimental group by the random number table method, with 32 children in each group. The control group was treated with maxillary protraction orthodontics, and the experimental group was treated with maxillary protraction orthodontics combined with soft-tissue smile aesthetic reconstruction. The craniofacial hardtissue indicators, soft-tissue aesthetic indicators and smile-related aesthetic indicators were compared between the two groups. Results The SNA, Bs-HRL, facial convexity angle, Pos-HRL and nasolabial angle in the experimental group were larger than those in the control group, and the SNB angle, U1-L1, U1-NA, mentolabial angle and soft-tissue facial angle were smaller than those in the control group (P <0.05). The smile index of the experimental group was higher than that of the control group, and the smile height, gingival exposure and smile width were lower than those of the control group (P <0.05). Conclusion Maxillary protraction orthodontics combined with soft-tissue smile aesthetic reconstruction achieves definite therapeutic effect for children with maxillary retrusion and anterior crossbite, which can improve soft-tissue appearance and smile aesthetic effect.