Objective To explore the effect of minimally invasive crown lengthening surgery combined with nano-resin on dental aesthetic satisfaction and periodontal indexes in patients with subgingival wedge-shaped defect. Methods A total of 60 patients with subgingival wedge-shaped defect admitted to our hospital from January 2019 to October 2023 were selected as the research subjects, and they were randomly divided into the reference group and the experimental group according to the random number table method, with 30 patients in each group. The reference group was treated with traditional crown lengthening surgery combined with nano-resin bonding restoration, and the experimental group was treated with minimally invasive crown lengthening surgery combined with nano-resin bonding restoration. The dental aesthetic satisfaction, periodontal indexes and pain degree were compared between the two groups. Results The dental aesthetic satisfaction rate in the experimental group (96.67%) was higher than that in the reference group (73.33%) (P <0.05). After treatment, the PD, TM, BI and AL in the experimental group were all better than those in the reference group (P <0.05). The VAS scores at 1, 3 and 5 days after surgery in the experimental group were all lower than those in the reference group (P <0.05). There was no significant difference in the VAS score at 7 days after surgery between the two groups (P >0.05). Conclusion The application of minimally invasive crown lengthening surgery combined with nano-resin in patients with subgingival wedge-shaped defect can improve the dental aesthetic satisfaction, optimize the periodontal indexes, facilitate the alleviation of pain, and enhance the overall restoration effect, which is worthy of clinical application.