Diode laser–assisted periosteal fenestration for peri‐implant vestibuloplasty: A clinical technique

BACKGROUND: Peri-implant mucogingival deficiencies, characterized by a shallow vestibule and insufficient attached mucosa (AM), can compromise plaque control and maintenance. Periosteal fenestration offers a graft-free alternative but remains limited by technique sensitivity and restricted surgical access. This report introduces a hybrid diode laser-assisted periosteal fenestration protocol (Hu-PF) designed to improve clinical applicability while preserving biological safety. METHODS: The Hu-PF protocol separates surgical functions by restricting diode laser use to controlled soft-tissue dissection and performing definitive periosteal fenestration mechanically under irrigation. A representative case, supplemented by additional clinical examples, is presented to illustrate the procedural workflow. RESULTS: The technique enabled predictable vestibular deepening and increased AM, with stable outcomes observed during follow-up. In the representative case, AM increased by approximately 6 mm at 1 week and stabilized at approximately 4 mm at 18 months, with maintained results at 3 years. CONCLUSIONS: The Hu-PF protocol represents a clinically applicable modification of periosteal fenestration-based vestibuloplasty that improves surgical operability while preserving biological safety, providing a practical graft-free option for peri-implant mucogingival management. KEY POINTS: The Hu-PF technique facilitates vestibuloplasty in anatomically challenging sites where periosteal suturing or graft stabilization is difficult, such as posterior regions or areas with prosthetic restorations. The protocol confines diode laser use to controlled soft-tissue dissection for hemostasis and visibility, whereas definitive periosteal fenestration is performed mechanically to stabilize the mucogingival junction without graft harvesting. The technique enables predictable vestibular deepening and maintenance of attached mucosa, with stable outcomes observed during follow-up. PLAIN LANGUAGE SUMMARY: Patients with dental implants may have insufficient firm gum tissue and a shallow vestibule, making oral hygiene difficult and increasing the risk of inflammation. Traditional grafting can improve these conditions but requires a donor site and complex handling. Periosteal fenestration is a graft-free alternative, but it can be difficult to perform in areas with limited access. This report introduces a practical hybrid approach (Hu-PF) that uses a small diode laser only for soft-tissue separation to improve visibility and control bleeding, whereas a rotary instrument is used under water cooling to safely create a small periosteal window. By separating these steps, the technique maintains the handling advantages of the diode laser while reducing the risk of heat damage to bone. The approach enables increased vestibular depth and firm gum tissue, with stable outcomes over time. Hu-PF may be a useful option when grafting is not desirable or when advanced laser equipment is not available.