The anterior region plays a crucial role in the aesthetic harmony of the face. The correct shape and position of the anterior teeth determines the unique expression of facial aesthetic factors such as lip-dental relationship, smile line, lip protrusion, chin shape, and nasolabial-chin relationship in the facial appearance. Therefore, the scientific clinical management of the shape and position of the front teeth often provides the finishing touch to the aesthetic expression of the face. The clinical application of the pile crown technique in cosmetic restorations has been poorly reported in the literature among the numerous treatment methods. In this paper, the unique clinical status and significance of this treatment technique in the aesthetic restorative treatment of anterior teeth is discussed through the clinical observation of 126 cases. Data and methods I. Clinical data 1. Source of cases: 126 patients with mild malocclusion in the anterior region with 504 teeth, including 84 females and 42 males, aged 18-45 years old, average 31.5 years old, were seen in our department from June 2004 to December 2009. 2. Mastery of indications: good general condition, good compliance, and good psychological adaptation status. The function of the oral and jaw system was coordinated, there was no obvious periodontal disease, and only mild malformation in the anterior region, but it had a significant impact on the aesthetics. 3. The selection of different tooth positions and materials is shown in Table 1. 4. Informed consent: The patient was carefully introduced to various optional treatment methods before surgery, and their advantages and disadvantages and possible complications were analyzed, and the patient’s psychological expectations were adjusted to a reasonable level and signed an informed consent form. Clinical treatment process 1. Pre-prosthetic preparation: Take frontal and lateral cephalometric images, frontal and lateral smile images, take study models, take flexural body layer films, determine the restoration design, and perform preoperative periodontal cleaning. 2.Endodontic treatment: one-time endodontic treatment for living pulp teeth and conventional endodontic treatment for infected pulp. 3.Mold of pile core: After one week of observation, the pile was prepared and 3-5L of root filling was left in the apical 1/3 section to make a mold of pile core with wax. 4.Cast porcelain and alloy casting nuclei should be sent to the technician’s office to make solid nuclei. 5.Adhesive pile nucleus and dental preparation to make impression and model. 6.Send the working model to the technician’s office to make the full crown. 7.Trial fitting, adjustment and cementation of the full crown to complete the whole restoration treatment. 8.Take a front and side smile image after treatment, and make a memory model. Third, clinical follow-up observation One week after the completion of the treatment, if there is no abnormality, then in January, March, June, one year, two years after the operation for follow-up, and every 3-6 months after regular follow-up. The content of follow-up observation: patient self-satisfaction questionnaire, clinical examination for gingival staining, chipped porcelain, gingivitis, abnormal loosening and excessive wear, etc., and X-ray apical film to observe whether there are abnormal images in the apical area. At the same time, the publicity and education of oral hygiene maintenance and plaque control related knowledge was carried out. Results All 504 anterior teeth of 126 patients were treated with pile core crown restorations. Except for 2 cases of post root canal disease and 1 case of chipped porcelain on the incisive end and labial surface, all other cases achieved the ideal expected results in terms of self-satisfaction, clinical results and observation of apical radiographs. Discussion With the increase of social interaction and the improvement of living standard, the aesthetics of the face is getting more and more attention, and patients with aesthetic defects have a stronger and stronger desire for treatment. In the past, full-crown restorations and orthodontic methods of moving teeth were often used to solve the aesthetic problems of anterior tooth morphology and position. However, the former has the potential risk of medical pulp penetration for teeth with obvious misalignment; while the latter has problems such as long procedure, affecting chewing and work, and ring legacy. The pile crown is used for cosmetic restorative treatment of anterior teeth by truncating the aesthetically dislocated crown while preserving the root, and using the angle adjustment between the crown core and the root pile to correct the position of the crown, so that it can achieve a harmonious aesthetic effect with the other natural crowns of the anterior segment. This expands the indications for cosmetic dentistry and achieves the clinical effects of short treatment, good results, repeatable outer crowns, few complications, and also has the clinical significance of functional restoration and optimal biomechanical properties. The clinical application of this technique should pay attention to the mastery of indications and the selection of different restorations. The root to be piled must be free of significant periodontal disease and must be located in the alveolar bone at least as long as the crown length of the adjacent tooth. The positive and negative torque of the crown must not be too large to avoid the formation of an excessive angle of intersection between the crown core and the root pile, which could lead to a potential risk of fracture of the restoration in a functional state due to stress concentration. In conclusion, the pile crown technique is a practical aesthetic dental technique for localized mild malocclusion in the anterior region, and is worthy of clinical promotion in primary hospitals as long as the clinical indications and operating techniques are mastered, with reliable aesthetic results and good patient compliance, and the crowns can be repeatedly produced.