Objective To analyze the effect of pulp preservation technique combined with aesthetic orthodontic treatment on aesthetic effect and pulp status in patients with anterior tooth defect and concomitant orthodontic indication. Methods A total of 80 patients with anterior tooth defect and concomitant orthodontic indication admitted to Linxian County Hospital from January to December 2024 were selected, and they were divided into the control group and the observation group by the random number table method, with 40 patients in each group. The control group received conventional orthodontic treatment combined with restoration, and the observation group received pulp preservation technique combined with aesthetic orthodontic treatment. The aesthetic effect, pulp status, periodontal health indicators and complication rate were compared between the two groups. Results The USPHS score of the observation group after treatment was higher than that of the control group (P <0.05). The positive rate of pulp vitality in the observation group was higher than that in the control group, while the incidence of periapical lesions and tooth sensitivity was lower than that in the control group (P <0.05). The BI, PD and PLI of the observation group after treatment were lower than those of the control group (P <0.05). The incidence of complications in the observation group (5.00%) was lower than that in the control group (20.00%) (P <0.05). Conclusion For patients with anterior tooth defect and concomitant orthodontic indication, pulp preservation technique combined with aesthetic orthodontic treatment can improve pulp vitality and aesthetic effect, help to maintain periodontal health, and reduce the risk of complications. It is a safe and effective comprehensive treatment protocol.