Objective To analyze the effect of zirconia all-ceramic crowns with different margin designs on periodontal health indicators and overall aesthetic effect in patients undergoing aesthetic restoration of anterior teeth. Methods A total of 76 patients who underwent aesthetic restoration of anterior teeth in the Department of Stomatology, Rudong People’s Hospital from May 2023 to May 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 38 patients in each group. The control group received right-angle shoulder margin design, and the observation group received chamfer shoulder margin design. The periodontal health indicators, overall aesthetic effect and gingival soft tissue aesthetic effect were compared between the two groups. Results At 12 months after restoration, the periodontal health indicators in the observation group were all lower than those in the control group (P<0.05). At 12 months after restoration, both patient and physician aesthetic scores of the observation group were higher than those of the control group (P<0.05). At 12 months after restoration, the PES score of the observation group was higher than that of the control group (P<0.05). Conclusion In the aesthetic restoration of zirconia all-ceramic crowns, the application of chamfer shoulder margin design is conducive to maintaining periodontal health, and can optimize overall aesthetic effect and gingival soft tissue aesthetic performance.