Objective To explore the effect of 3D printing technology applied in metal framework removable partial denture restoration on denture aesthetic effect in elderly patients with dentition defect. Methods A total of 50 elderly patients with dentition defect who received metal framework removable partial denture restoration at Nanjing Liuhe ZHANG Yan Dental Clinic from June 2024 to June 2025 were selected, and they were divided into the control group and the observation group according to different treatment methods, with 25 patients in each group. The control group adopted the model investing technology, and the observation group adopted 3D printing technology. The clinical objective indicators, comprehensive dental function, integrity and stability of restorations, gingival health status and denture aesthetic effect were compared between the two groups. Results At 4 weeks after restoration, the number of pressure points, fit gap and surface roughness in the observation group were lower than those in the control group, and the masticatory efficiency was higher than that in the control group (P <0.05). There was no statistically significant difference in occlusal force between the two groups (P >0.05). There was no statistically significant difference in comprehensive dental function between the two groups (P>0.05). The integrity and stability rate of restorations in the observation group at 2 weeks after restoration was higher than that in the control group (P<0.05). There was no statistically significant difference in the proportion of gingival health between the two groups (P>0.05). The denture aesthetic score of the observation group at 4 weeks after restoration was higher than that of the control group (P <0.05). Conclusion For metal framework removable partial denture restoration in elderly patients with dentition defect, 3D printing technology can reduce the framework fit gap and surface roughness, decrease mucosal pressure points, improve masticatory efficiency, framework stability and denture aesthetic effect, without altering gingival health and basic dental function, and can improve the wearing experience of elderly patients.