Background <p>Pulpotomy is a commonly used approach for treating deep caries in primary teeth. In recent years, diode lasers have been explored the use in pulpotomy. This study systematically reviewed the clinical and radiographic efficacy of diode lasers in pulpotomy and evaluated their feasibility and safety as an alternative treatment modality.</p> Methods <p>This systematic review searched PubMed, Embase and the Cochrane Library for all published articles in the English language from inception to August 31, 2025. The medical subject headings (MeSH) terms and free-text keywords were used. The Cochrane collaboration risk assessment tool was used to evaluate the quality of the literature. Meta-analysis was performed using RevMan 5.4. Heterogeneity was evaluated using Cochran’s Q test and the I² statistic.</p> Results <p>The results of this study showed that comparing with other treatments, no significant differences in clinical or radiographic success rates at every follow-up period (<i>P</i> &gt; 0.05). However, diode lasers significantly decreased the occurrence of pathologic widening of the periodontal space (<i>P</i> &lt; 0.05). Laser wavelength did not significantly influence the outcome (<i>P</i> &gt; 0.05). When using zinc oxide eugenol (ZOE) as the pulp capping material, diode lasers lowered the incidence of pathological widening of the periodontal ligament space (<i>P</i> &lt; 0.05). Sensitivity analyses confirmed that most results were consistent, although some subgroup outcomes were affected when individual studies were excluded. Funnel plot examination indicated no evidence of publication bias.</p> Conclusion <p>Compared with other methods, diode laser treatment demonstrated similar clinical and radiographic success rates and showed potential benefits in reducing the incidence of pathologic widening of periodontal space. Therefore, diode laser-assisted pulpotomy may be considered a viable alternative therapy.</p> Trial registration <p>The study was submitted to the Open Science Framework platform&#xa0;[<a href="https://osf.io/rweuq/overview?view_only=fa297ad91199454581a03dedc1b3d4e0">https://osf.io/rweuq/overview?view_only=fa297ad91199454581a03dedc1b3d4e0</a>].</p>