Background <p>Oral fibroma is a prevalent benign lesion of the oral mucosa, typically resulting from persistent inflammation. Although traditional scalpel excision is widely used, diode laser surgery has gained attention for its minimally invasive nature and improved clinical outcomes.</p> Objective <p>to evaluate the clinical and histological outcomes of diode laser excision compared to traditional scalpel excision in the treatment of oral fibromas.</p> Materials and methods <p>48 patients clinically diagnosed with oral fibroma were randomly divided into two groups: a diode laser group (<i>n</i> = 24) and a scalpel group (<i>n</i> = 24). All patients underwent complete lesion excision followed by a standardized postoperative clinical assessments. The evaluated clinical measures encompassed intraoperative bleeding, postoperative pain, edema, functional interference, clinical healing, scar development, and patient satisfaction. Histological specimens were evaluated for structural preservation and clarity of diagnosis.</p> Results <p>The diode laser group showed significantly less intraoperative bleeding, reduced postoperative discomfort and swelling, accelerated wound healing, and enhanced aesthetic results relative to the scalpel group. Histopathological evaluation revealed better tissue preservation in the laser group, despite minor thermal artifacts. All patients in the laser group reported excellent satisfaction, whereas only 41.6% of the scalpel group did.</p> Conclusion <p>Diode laser excision of oral fibromas demonstrated significant clinical and histological benefits compared to conventional scalpel surgery. This approach enhances patient comfort, accelerates recovery, and provides clearer histopathological margins, supporting its broader adoption in soft tissue oral surgery.</p> Clinical trial registration <p>Clinical trial number: Not applicable</p>