Objective To investigate the application effect of cast porcelain veneer in oral aesthetic restoration and its influence on periodontal status of patients. Methods A total of 78 patients with oral aesthetic restoration admitted to our hospital from January 2023 to June 2024 were randomly divided into control group and observation group, with 39 patients in each group. The control group was repaired with porcelain full crown, and the observation group was repaired with cast porcelain veneer. The repair aesthetics, periodontal health status, adverse reactions and repair satisfaction were compared between the two groups. Results The scores of morphology, color, edge beauty and translucency in the observation group were higher than those in the control group, and the differences were statistically significant (P <0.05). After repair, AL, PD and BI in the observation group were lower than those in the control group, and the differences were statistically significant (P <0.05). The incidence of adverse reactions in the observation group was 2.56%, which was lower than 17.95% in the control group, and the difference was statistically significant (P <0.05). The repair satisfaction of the observation group was 97.44%, which was higher than 79.49% of the control group, and the difference was statistically significant (P <0.05). Conclusion Cast porcelain veneers in oral aesthetic restoration has a higher aesthetic degree, less impact on the periodontal health status of patients, lower probability of adverse reactions, and higher patient satisfaction with repair.