Objective To analyze the effect of immediate aesthetic restoration after minimally invasive root canal preparation on the prognosis of crown-root fracture of immature permanent teeth. Methods A total of 76 patients with crown-root fracture of immature permanent teeth admitted to the Department of Stomatology, Peixian Hospital of Traditional Chinese Medicine from March 2021 to March 2026 were selected, and they were divided into the conventional group and the study group by the random number table method, with 38 patients in each group. The conventional group received traditional root canal treatment, and the study group received immediate aesthetic restoration after minimally invasive root canal preparation. The treatment effect, treatment-related indicators, complication rate and aesthetic satisfaction were compared between the two groups. Results The excellent and good rates of root development and apical healing in the study group were higher than those in the conventional group (P <0.05). The operative time, postoperative pain duration and overall treatment duration in the study group were shorter than those in the conventional group (P <0.05). The incidence of complications in the study group (0) was lower than that in the conventional group (18.42%) (P <0.05). The aesthetic satisfaction rate of the study group (100.00%) was higher than that of the conventional group (78.95%) (P <0.05). Conclusion Immediate aesthetic restoration after minimally invasive root canal preparation achieves favorable effects for patients with crown-root fracture of immature permanent teeth. It can reduce damage to the root canal system, shorten recovery time, lower the incidence of complications, promote continuous root development and wound healing with stable long-term prognosis. Meanwhile, patients show high aesthetic satisfaction for restoration effects. It is a minimally invasive toothpreserving protocol worthy of clinical application.