Objective：To 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. The effects of gender，incision type（intrasulcular incision，ISI；papilla based incision，PBI），and the restorations status（no restoration，NR；crown margin，CM）on gingival recession in the anterior esthetic zone after EMS were analyzed. Results：According to the inclusion criteria，data of 53 clinical crowns and 78 gingival papillae were collected. There were statistical differences in the clinical crown height（H1），gingival nipple height（H2）and cut-margin gingival papilla distance（H3）before and 1 year after EMS（P < 0.05）. Gender and incision type had no significant effect on postoperative gingival recession. According to whether the restoration has contrast，the change of clinical crown height（ΔH1）and the change of cut-margin gingival papilla distance （ΔH3）had statistically significant difference（P < 0.05）. Conclusion：There is a certain degree of gingival retraction after EMS in anterior maxillary esthetic zone. The presence of restoration exacerbates gingival retraction，affecting the esthetic effect of anterior teeth. It is clinically significant to fully communicate with patients before surgery.