Objective To analyze the effect of different degrees of root canal obturation on efficacy and aesthetics in patients with dental pulp disease. Methods A total of 62 patients with dental pulp disease who received root canal obturation in Fengxian People's Hospital from June 2023 to June 2025 were selected as the research subjects, and they were divided into group A (20 patients, obturation volume slightly exceeding the apical area), group B (21 patients, obturation volume level with the apex), and group C (21 patients, obturation volume 2 mm away from the apical area) according to different obturation degrees. The treatment effect, aesthetics, masticatory function, inflammatory factor levels and adverse reactions were compared among the three groups. Results The total effective rate of treatment in group B was 100%, which was higher than 70.00% in group A and 66.67% in group C (P <0.05). The aesthetics score and masticatory function of group B after treatment were higher than those of group A and group C (P <0.05). The levels of CRP and IL-6 in group B after treatment were lower than those in group A and group C, and the incidence of adverse reactions was lower than that of group A and group C (P <0.05). Conclusion In the clinical treatment of dental pulp disease with root canal obturation, the normal obturation volume has the best effect. It can effectively improve aesthetics, reduce the incidence of adverse reactions, and decrease inflammatory indicators.