Objective To explore the effect of crown lengthening surgery in patients with oral aesthetic restoration. Methods A total of 60 patients with oral aesthetic restoration admitted to the Department of Stomatology, Guangyuan Central Hospital from January 2023 to May 2024 were selected. They were divided into the control group and the observation group by the lottery method, with 30 patients in each group. The control group was treated with gingivectomy, and the observation group was treated with crown lengthening surgery. The periodontal indexes, the distance from the restorative margin to the bone crest (RM-BC) of the affected tooth, the distance from the restorative margin to the gingival margin (RM-GM), gingival crevicular fluid indexes and smile line classification were compared between the two groups. Results After surgery, the PLI, MOB, SBI and PD in the observation group were lower than those in the control group (P <0.05). After surgery, the RM-BC and RMGM in the observation group were higher than those in the control group (P <0.05). After surgery, the levels of TNF-α, IL- 1β and ICAM-1 in the observation group were lower than those in the control group (P <0.05). The classification of the smile line in the observation group was better than that in the control group (P <0.05). Conclusion For patients with oral aesthetic restoration, crown lengthening surgery has advantages in improving periodontal health, optimizing restoration position, reducing gingival inflammation, and enhancing the effect of aesth etic restoration.