Objective To observe the effect of different root canal filling methods combined with iRoot SP on periodontal aesthetic scores and gingival crevicular fluid inflammatory factor levels in patients with dental pulp disease. Methods A total of 60 patients with dental pulp disease admitted to the Department of Stomatology, Shenzhen Bao'an Women's and Children's Hospital from March 2023 to December 2024 were selected and divided into the control group and the experimental group according to the random number table method, with 30 patients in each group. The control group was treated with traditional lateral compaction root canal filling combined with iRoot SP, and the experimental group was treated with warm gutta-percha vertical compaction root canal filling combined with iRoot SP. The periodontal aesthetic scores, gingival crevicular fluid inflammatory factor levels, clinical efficacy and complications were compared between the two groups. Results The scores of gingival margin contour, gingival papilla morphology, soft tissue color and texture in the experimental group after treatment were higher than those in the control group (P <0.05). The levels of hs-CRP, TNF-α and IL-1β in the experimental group after treatment were lower than those in the control group (P <0.05). The total clinical effective rate of treatment in the experimental group (96.67%) was higher than that in the control group (83.33%) (P <0.05). The incidence of complications in the experimental group (6.67%) was lower than that in the control group (23.33%) (P <0.05). Conclusion Compared with the traditional filling method, warm gutta-percha vertical compaction root canal filling combined with iRoot SP has a better effect on improving periodontal aesthetics in patients with dental pulp disease, which is helpful to reduce the levels of inflammatory factors, enhance therapeutic effect, and have higher clinical application value.