Objective To investigate the effect of composite resin direct adhesive restoration in patients with different types of anterior aesthetic defects. Methods A total of 106 patients with anterior aesthetic defects who underwent aesthetic restoration at Jincheng Infectious Disease Hospital from June 2022 to July 2024 were selected. According to different restoration indications, they were divided into group A (tooth defect, n=48), group B (tooth discoloration, n=32), and group C (abnormal interdental space, n=26). The restoration success rate, restoration effect, wear resistance of restorations, periodontal health indicators and complications were compared among the three groups. Results There was no significant difference in restoration success rate among the three groups (P>0.05). There were no signiffcant differences in the excellent and good rates of marginal adaptation, surface integrity, color matching and periodontal health of restorations among the three groups (P>0.05). The wear depth of restorations in group C was lower than that in group A and group B, and the excellent and good rate of wear resistance was higher than that in group A and group B (P<0.05). The PPD, GI and SBI in three groups at 6 months after operation were lower than those before operation (P<0.05), but there was no signiffcant difference in PPD, GI and SBI between the three groups (P>0.05). There was no signiffcant difference in the incidence of complications among the three groups (P>0.05). Conclusion Composite resin direct adhesive restoration demonstrates good adaptability in patients with different types of anterior aesthetic defects. It can effectively restore the shape and aesthetics of anterior teeth, with minimally invasive operation and few complications. The wear resistance of restorations is better for abnormal interdental space. Individualized treatment plans should be formulated according to the type of defect in clinical practice.