Objective To explore the clinical effect of cast porcelain veneers and porcelain-fused-to-metal crowns in oral aesthetic restoration and its inffuence on periodontal condition. Methods A total of 70 patients undergoing oral aesthetic restoration in Shanxi Zhongzhi Dental Hospital from January 2024 to December 2025 were selected. According to the random number table method, they were divided into the reference group and the study group, with 35 patients in each group. The reference group received porcelain-fused-to-metal crown restoration, and the study group received cast porcelain veneer restoration. The periodontal condition, restoration aesthetics, restoration satisfaction and complication rate were compared between the two groups. Results The levels of AL, BI and PD in the study group after treatment were lower than those in the reference group (P<0.05). The scores of all dimensions of restoration aesthetics in the study group were higher than those in the reference group (P<0.05). The restoration satisfaction of the study group (97.14%) was higher than that of the reference group (77.14%) (P<0.05). The incidence of complications in the study group (2.86%) was lower than that in the reference group (22.86%) (P<0.05). Conclusion Compared with porcelain-fused-to-metal crowns, the application of cast porcelain veneers in oral aesthetic restoration can effectively improve periodontal condition and restoration aesthetics, reduce the incidence of complications, and increase restoration satisfaction.