Objective To analyze the effect of maxillary premolar root canal therapy combined with single crown restoration on the restoration success rate in patients undergoing maxillary premolar cusp restoration. Methods A total of 80 patients undergoing maxillary premolar cusp restoration admitted to the Department of Stomatology of Luodian County Hospital of Traditional Chinese Medicine from January 2023 to January 2024 were selected as the research subjects, and they were divided into the control group and the observation group according to different treatment methods, with 40 patients in each group. The control group was treated with single crown restoration alone, and the observation group was treated with maxillary premolar root canal therapy combined with single crown restoration. The restoration success rate, aesthetics and gingival health were compared between the two groups. Results The restoration success rate of the observation group was 95.00%, which was higher than 75.00% of the control group (P <0.05). At 6 months after restoration, the scores of surface smoothness, tooth morphology, color matching and retention aesthetics in the observation group were higher than those in the control group (P <0.05). The proportion of gingival health grade A in the observation group was 92.50%, which was higher than 72.50% in the control group (P <0.05). Conclusion The application of maxillary premolar root canal therapy before single crown restoration in patients with maxillary premolar cusp restoration can effectively improve the success rate of tooth restoration, enhance dental aesthetics, and improve gingival health.