Objective To compare the aesthetic effect of zirconia full crowns and porcelain-fused-to-metal crowns in full crown restoration. Methods The clinical data of 82 patients requiring full crown restoration admitted to Hangzhou Xiaoshan Second People’s Hospital from August 2023 to August 2025 were retrospectively analyzed. All patients were divided into the control group and the study group according to different restoration methods, with 41 patients in each group. The control group received porcelain-fused-to-metal full crown restoration, and the study group received zirconia full crown restoration. The orofacial aesthetic effect, adverse reactions and restoration satisfaction were compared between the two groups. Results The scores of tooth color matching, morphological coordination, gingival marginal adaptation, individual aesthetic item and total aesthetic score in the study group were higher than those in the control group (P<0.05). The incidence of adverse reactions in the study group (7.32%) was lower than that in the control group (24.39%) (P<0.05). The restoration satisfaction rate of the study group (95.12%) was higher than that of the control group (80.49%) (P<0.05). Conclusion Compared with porcelain-fused-to-metal full crown restoration, zirconia full crown restoration has more advantages in orofacial aesthetic effect, lower incidence of postoperative adverse reactions, and higher patient satisfaction. It can be used as a better choice for clinical dental restoration.