Objective To study the clinical effect of cast porcelain veneer and porcelain crown in oral aesthetic restoration. Methods A total of 152 patients with oral aesthetic restoration admitted to the Department of Stomatology, Hedong District Erhaoqiao Street Community Health Service Center, Tianjin from August 2022 to February 2023 were randomly divided into control group and experimental group, with 76 patients in each group. The control group was repaired with porcelain full crown, and the experimental group was repaired with cast porcelain veneer. The aesthetic repair effect, functional score, periodontal related indexes and adverse reactions were compared between the two groups. Results There was no significant difference in the aesthetic repair score between the two groups at 1 month after repair (P >0.05). At 3 and 6 months after repair, the aesthetic repair score of the experimental group was higher than that of the control group (P <0.05). The scores of comfort, language ability, masticatory ability and aesthetics in the experimental group were higher than those in the control group (P <0.05). The periodontal pocket depth, gingival bleeding degree score, periodontitis attachment loss degree and plaque index score in the experimental group were lower than those in the control group (P <0.05). The incidence of adverse reactions in the experimental group (1.32%) was lower than that in the control group (9.21%) (P <0.05). Conclusion In oral aesthetic restoration, porcelain crown can improve the aesthetic repair effect, optimize periodontal related indicators, improve dental function, and reduce adverse reactions. It is worthy of application.