Objective To explore the effect of microscopic root canal therapy combined with inlay restoration on aesthetic effect in patients with tooth defect. Methods A total of 96 patients with tooth defect admitted to Nanjing Stomatological Hospital from January 2023 to August 2025 were selected as the research subjects, and they were divided into the control group and the observation group by the random number table method, with 48 patients in each group. The control group was treated with inlay restoration, and the observation group was treated with microscopic root canal therapy combined with inlay restoration. The aesthetic effect, restoration effect, and gingival crevicular ffuid inffammatory factor levels were compared between the two groups. Results The aesthetic effect score of the observation group at 6 months after operation was higher than that of the control group (P<0.05). The restoration effect indicators of the observation group were better than those of the control group (P<0.05). The levels of all inffammatory factors in gingival crevicular ffuid of the observation group at 6 months after operation were lower than those of the control group (P<0.05). Conclusion The application of microscopic root canal therapy combined with inlay restoration technology in the treatment of tooth defect can achieve ideal restoration effect while maintaining excellent aesthetic effect of the affected tooth, and simultaneously help to reduce the levels of inffammatory factors in gingival crevicular ffuid.