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BACKGROUND: To achieve a unified aesthetic restoration effect, digital smile design technologies have been introduced and gradually applied in clinical practice. However, due to the limitations and authenticity of the software’s own dental pictures, the promotion of the software encountered difficulties. Researchers found that using the digital smile design software to import previous similar cases may optimize this problem, making the design of the prosthesis authentic and personalized. OBJECTIVE: To verify the advantages and limitations of the case-based digital smile design method by comparing the effect of the case-based digital smile design method and the traditional aesthetic restoration method in the aesthetic restoration of anterior teeth. METHODS: From October 2018 to October 2020, 36 patients requiring aesthetic restoration of anterior teeth at the Department of Prosthodontics in Tianjin Stomatological Hospital were selected and randomly divided into experimental group and control group according to the sequence of treatment, with 18 patients in each group. In the experimental group, digital smile design technology was used to collect and import digital photos, and the diagnostic wax pattern and diagnostic decoration were made based on the pictures of the prostheses from the most similar cases in the past. Patients could obtain the digital smile design drawing and three-dimensional oral preview form for doctor-patient communication and design adjustment. The control group was treated with digital photography combined with colorimetric palettes. Immediately after aesthetic repair, patient satisfaction evaluation was performed. Aesthetic prostheses were clinically evaluated as per the modified United States Public Health Service (USPHS) criteria at 2 weeks, 6 months, and 12 months after aesthetic repair. RESULTS AND CONCLUSION: In terms of patient satisfaction, patients in the experimental group were more satisfied with the shape and color of the prosthetics than those in the control group (P < 0.05), and there was no significant difference in the comfort of the prosthetics and the time to seek medical treatment (P > 0.05). There was no significant difference between the two groups in postoperative prosthesis integrity, periodontal healthy, tooth sensitivity, edge fit, color matching, and occlusal relationship at 2 weeks after restoration (P > 0.05), while the experimental group was superior to the control group in color matching at 6 and 12 months after restoration (P < 0.05). To conclude, the case-based digital smile design technique is superior to the traditional method in doctor-patient communication, prosthesis color and shape; however, there are limitations such as the limited number of previous cases and the increased workload and cost of the digital smile design process. [ABSTRACT FROM AUTHOR]