Objective: Evaluate the effect of incision design and restorations on gingival recession after endodontic microsurgery（EMS） in anterior maxillary esthetic zone. Methods: Data from 53 EMS cases in the anterior esthetic zone（with a follow-up period of at least 1 year） were collected. Cases were categorized based on gender, incision type（intrasulcular incision , ISI ; papilla based incision,PBI）,and the presence of restorations（no restoration, NR; crown margin, CM）. The influence of different factors on gingival recession in the anterior esthetic zone after EMS were analyzed. Results: Data of 53 clinical crowns and 78 gingival papillae were collected. Gender had no significant effect on gingival recession. The incision type had no significant effect on gingival recession,but the gingival papilla was significantly reduced by ISI（P ＜ 0.05）. According to whether the restoration has contrast, the change of Clinical crown height (ΔH1) and the change of cut-margin gingival papilla distance(ΔH 3) had statistically significant difference（P ＜ 0.05）.CM group ΔH1 = （0.476 ± 0.387） mm and NR group ΔH1 = （0.146 ± 0.137） mm；CM Group ΔH3 = （0.221 ± 0.354）mm and NR group ΔH3 = （0.023 ± 0.338）mm. Conclusion: There was a certain degree of gingival retraction after EMS in anterior maxillary esthetic zone, and the presence of restoration would aggravate gingival retraction and affect the esthetic effect of anterior teeth.We need to communicate with the patient before the operation, with clinical guidance.