Objective To explore the effect of nano-composite resin on periodontal health status in patients undergoing aesthetic restoration of maxillary anterior teeth. Methods A total of 130 patients with maxillary anterior tooth defect treated in our hospital from January to October 2025 were selected, and they were divided into the control group and the observation group by the random number table method, with 65 patients in each group. The control group was restored with light-curing composite resin, and the observation group was restored with nano-composite resin. The periodontal health status, masticatory function, aesthetic repair effect and complication rate were compared between the two groups. Results At 6 months after operation, the GI, SBI, PLI and MD in the two groups were lower than those before operation, and those in the observation group were lower than those in the control group (P <0.05). At 6 months after operation, the occlusal force and masticatory efficiency in the observation group were higher than those in the control group (P <0.05). The scores of marginal adaptation, color matching, restoration integrity, risk of restoration fracture, restoration dislodgement, secondary caries risk and gingival health in the observation group were lower than those in the control group (P <0.05). The incidence of complications in the observation group (7.69%) was lower than that of the control group (24.62%) (P <0.05). Conclusion The application of nano-composite resin in aesthetic restoration of maxillary anterior teeth can effectively improve patients’ periodontal health status, optimize masticatory function, improve the aesthetic repair effect, help to reduce the incidence of complications, which possesses definite clinical application value.