Objective To explore the effect of tooth fragment reattachment combined with vital pulpotomy on dental aesthetics and periodontal indexes in young permanent anterior teeth with traumatic crown fracture and pulp exposure. Methods From October 2022 to September 2024, 106 patients with young permanent anterior teeth suffering from traumatic crown fracture and pulp exposure, who were admitted to Shuyang Mercy Hospital, were selected as the research subjects. They were divided into the control group and the observation group according to different treatment methods, with 53 patients in each group. The control group was treated with resin restoration, and the observation group was treated with tooth fragment reattachment combined with vital pulpotomy. The treatment effect, dental aesthetics, periodontal indexes and adverse reactions were compared between the two groups. Results The total effective rate of treatment in the observation group was 98.11%, which was higher than 84.91% in the control group (P <0.05). After treatment, the scores of dental color, marginal tightness and alignment in the observation group were higher than those in the control group (P <0.05). After treatment, the plaque index and sulcus bleeding index in the observation group were lower than those in the control group (P <0.05). There was no significant difference in the incidence of adverse reactions between the two groups (P >0.05). Conclusion The effect of tooth fragment reattachment combined with vital pulpotomy in the treatment of patients with young permanent anterior teeth with traumatic crown fracture and pulp exposure is good. It can effectively enhance dental aesthetics, improve periodontal indexes, and will not increase the risk of adverse reactions. It is worthy of clinical application.