Objective To observe the application of E-max cast porcelain technology in oral aesthetic restoration and its influence on aesthetics. Methods A total of 120 patients undergoing oral aesthetic restoration admitted to Suining Central Hospital from August 2021 to August 2023 were selected as the research subjects. They were divided into the control group and the observation group by the random number table method, with 60 patients in each group. The control group was treated with metal-ceramic full crown restoration, and the observation group was treated with E-max cast porcelain technology. The aesthetic effect, PES index, satisfaction and adverse reactions were compared between the two groups. Results The scores of restoration overall shape, marginal adaptation and restoration color in the observation group were higher than those in the control group (P <0.05). The scores of each PES index in the observation group were higher than those in the control group (P <0.05). The satisfaction of the observation group (96.67%) was higher than that of the control group (86.67%) (P <0.05). The incidence of adverse reactions in the observation group (1.67%) was lower than that in the control group (11.67%) (P <0.05). Conclusion The application of E-max cast porcelain technology in oral aesthetic restoration has a good effect. It can effectively reduce the incidence of adverse reactions, improve aesthetics and satisfaction, and is worthy of clinical application.