Objective To analyze the effect of porcelain-fused-to-metal crown restoration on tooth sensitivity and aesthetics in patients with maxillary anterior tooth defect. Methods A total of 186 patients with maxillary anterior tooth defect who were treated in the Department of Stomatology, Yangluo Branch of the Third People's Hospital of Hubei Province from June 2023 to June 2025 were selected as the research subjects. According to different restoration methods, they were divided into the control group and the observation group, with 93 patients in each group. The control group received light-curing composite resin fflling restoration, and the observation group was treated with porcelain-fused-to-metal crown restoration. The tooth sensitivity, tooth stability, aesthetics and complication rate were compared between the two groups. Results After restoration, the tooth sensitivity score of the observation group was lower than that of the control group (P<0.05). After restoration, the tooth stability score of the observation group was lower than that of the control group (P<0.05). After restoration, the aesthetics score of the observation group was higher than that of the control group (P<0.05). The incidence of complications in the observation group (6.45%) was lower than that in the control group (18.28%) (P<0.05). Conclusion Porcelain-fused-to-metal crown restoration for maxillary anterior tooth defect can alleviate tooth sensitivity symptoms, enhance tooth stability and aesthetic effect, with a low incidence of complications.