Objective To analyze the effect of immediate restoration and delayed restoration on periodontal indexes and aesthetic effects in patients with anterior tooth defect. Methods A total of 64 patients with anterior tooth defect who were treated in the Department of Oral and Maxillofacial Surgery, Changsha Stomatological Hospital from January 2022 to January 2023 were divided into the control group and the experimental group by the random number table method, with 32 patients in each group. The control group was given delayed restoration, and the experimental group was given immediate restoration. The periodontal indexes, aesthetic outcomes, subjective satisfaction and implant survival rate were compared between the two groups. Results At 10 months after restoration, the sulcus bleeding index, gingival index and plaque index of the experimental group were lower than those of the control group (P <0.05). The scores of PES and WES of the experimental group at 1, 2, 4 and 10 months after restoration were higher than those of the control group (P <0.05). The scores of each item and total score of subjective satisfaction in the experimental group were higher than those in the control group (P <0.05). The implant survival rate was 97.06% in the control group and 93.94% in the experimental group, with no significant difference between the two groups (P >0.05). Conclusion In the clinical restoration of anterior tooth defect, immediate restoration and delayed restoration show no significant difference in implant survival. However, immediate restoration has better aesthetic outcomes, and patients have better periodontal health and higher implant satisfaction.