Objective To explore the effect of minimally invasive crown lengthening surgery combined with resin restoration on the aesthetics of affected tooth in patients with subgingival wedge-shaped defect. Methods A total of 84 patients with subgingival wedge-shaped defect diagnosed and treated in Pukou Hospital of Traditional Chinese Medicine from January 2022 to December 2024 were selected, and they were divided into the control group and the observation group according to different treatment plans, with 42 patients in each group. The control group was treated with traditional crown lengthening surgery combined with resin restoration, and the observation group was treated with minimally invasive crown lengthening surgery combined with resin restoration. The aesthetics of affected tooth, clinical efffcacy, pain intensity, periodontal indicators and inffammatory factor levels were compared between the two groups. Results After treatment, the scores of PES and WES in the observation group were higher than those in the control group (P<0.05). There was no statistically signiffcant difference in the total effective rate between the two groups (P>0.05). The VAS scores of the observation group at 1, 3 and 5 days after treatment were lower than those of the control group (P<0.05). There was no statistically signiffcant difference in the pain score between the two groups at 7 days after operation (P>0.05). The probing depth, bleeding index and attachment loss of the observation group after treatment were lower than those of the control group (P<0.05). There was no statistically signiffcant difference in tooth mobility between the two groups (P>0.05). The levels of IL-1β, IL-6 and TNF-α in the observation group after treatment were lower than those in the control group (P<0.05). Conclusion Minimally invasive crown lengthening surgery combined with resin restoration has a deffnite effect in the treatment of subgingival wedge-shaped defect. It can effectively improve the aesthetics of affected tooth, reduce pain, and is conducive to improving periodontal indicators and inffammatory reactions.