Objective To explore the effect of different marginal positions of all-ceramic crown restorations on aesthetic coordination and periodontal health indicators in patients with anterior tooth defect. Methods A total of 80 patients with anterior tooth defect who visited the Department of Stomatology, Hongze Maternal and Child Health Hospital from September 2022 to September 2024 were selected, and they were divided into the control group and the observation group by the random number table method, with 40 patients in each group. The control group received gingival-marginal alignment method, and the observation group received supragingival margin method. The aesthetic coordination, periodontal health indicators, complication rate and patient satisfaction were compared between the two groups. Results At 6 and 12 months after restoration, the scores of color matching, contour, marginal adaptation and total aesthetic score in the observation group were higher than those in the control group (P<0.05). At 12 months after restoration, the GI, PD and SBI of the observation group were better than those of the control group (P<0.05). There was no statistically signiffcant difference in the incidence of complications between the two groups (P>0.05) . At 12 months after restoration, the scores of overall aesthetic effect, gingival health status, cleaning convenience and comfort in the observation group were higher than those in the control group (P<0.05). There were no statistically signiffcant differences in the scores of tooth shape and color between the two groups (P>0.05). Conclusion For the restoration of patients with anterior tooth defect, all-ceramiccrowns with supragingival margin design can improve aesthetic coordination, facilitate the long-term maintenance of periodontal tissue health, thereby enhancing patient treatment satisfaction, and no increased risk of complications is observed.