Objective: To explore the clinical effect of water mist laser (Neodymium laser) in the elongation of the aesthetic zone crown of maxillary anterior teeth and its influence on the depth of periodontal pockets (PD). Methods: 70 patients who underwent crown lengthening treatment in the aesthetic area of maxillary anterior teeth in our hospital from October 2023 to August 2025 were selected and divided into the observation group and the control group by random number table method, with n=35 in each group. The observation group underwent crown lengthening surgery using water mist laser (neodymium laser), while the control group underwent crown lengthening surgery using traditional surgical methods. Both groups were followed up for 3 months to compare the therapeutic effects. Results: The operation time of the observation group was shorter than that of the control group, and the intraoperative blood loss was less than that of the control group (P<0.05). After the operation, PD decreased in both groups, while GR and KGW increased. Moreover, PD in the observation group was lower than that in the control group, and GR and KGW were greater than those in the control group (P<0.05). After the operation, the PES, WES scores and total scores of both groups were increased compared with those before the operation (P<0.05), and the PES, WES scores and total scores of the observation group were higher than those of the control group (P<0.05). The incidence of complications in the observation group was 2.86%, which was lower than 17.14% in the control group (P<0.05). The excellent and good retention rate of the observation group was 100.00%, while that of the control group was 94.29%. The excellent and good retention rate of the restorations in the observation group was higher than that in the control group, but there was no difference (P＞0.05). Conclusion: The application of water mist laser (neodymium laser) in the crown lengthening surgery of the aesthetic zone of maxillary anterior teeth has the advantages of short operation time, less intraoperative bleeding, good postoperative periodontal recovery, excellent aesthetic effect and few complications. It can effectively improve the depth of periodontal pockets and is worthy of clinical promotion and application.