Objective To compare the differences in improving periodontal indexes and aesthetic effects between cast porcelain veneer and porcelain crown in oral aesthetic restoration. Methods A total of 67 patients who underwent oral aesthetic repair in Suqian Hospital of Suqian Hospital, Nanjing Gulou Hospital Group from February 2023 to February 2024 were selected as the research objects. According to the different treatment methods, they were divided into basic group (n =33) and study group (n =34). The basic group was given porcelain crown restoration, and the study group was given cast porcelain veneer restoration. The aesthetic effect, periodontal index, complications and satisfaction of the two groups were compared. Results After restoration, the scores of shape, color, edge beauty and translucency beauty in the study group were higher than those in the basic group (P <0.05). After restoration, the gingival bleeding index, attachment loss and periodontal pocket depth in the study group were lower than those in the basic group (P <0.05). The incidence of complications in the study group was 2.94%, which was lower than 24.24% in the basic group (P <0.05). The aesthetic effect and comfort satisfaction score of the study group were higher than those of the basic group (P <0.05). Conclusion Compared with porcelain full crown restoration, cast porcelain veneer restoration has better effect in patients with oral aesthetic restoration, which can improve the aesthetic effect and satisfaction of patients, improve periodontal index, and have lower risk of complications.