Objective To explore the effect of water mist neodymium laser on periodontal indicators in patients undergoing crown lengthening in the aesthetic zone of maxillary anterior teeth. Methods A total of 70 patients who received crown lengthening in the aesthetic zone of maxillary anterior teeth at Yangzhou Stomatological Hospital from October 2023 to August 2025 were selected as the research subjects. According to the random number table method, they were divided into the control group and the observation group, with 35 patients in each group. The control group was treated with traditional crown lengthening, and the observation group was treated with water mist neodymium laser for crown lengthening. The operation-related indicators, periodontal indicators, aesthetic effect, complication rate and restoration retention effect were compared between the two groups. 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 operation, the PD of the observation group was lower than that of the control group, while the KGW was higher than those of the control group (P<0.05). After operation, the scores of PES, WES and total score in the observation group were higher than those in the control group (P<0.05). The incidence of complications in the observation group (2.86%) was lower than that in the control group (17.14%) (P<0.05). The excellent and good rate of retention in the observation group was higher than that in the control group, but the difference was not statistically signiffcant (P>0.05). Conclusion The application of water mist neodymium laser in crown lengthening in the aesthetic zone of maxillary anterior teeth can shorten the operation time, reduce intraoperative blood loss, promote the recovery of postoperative periodontal tissues, improve the aesthetic restoration effect, and reduce the incidence of complications, without affecting the retention effect of the restoration.