To evaluate the effectiveness of alveolar ridge preservation (ARP) in periodontally compromised extraction sockets with simultaneous periodontal regeneration (PR) in adjacent teeth.

A total of 69 extraction sites were retrospectively evaluated and allocated into two groups according to the presence of interdental bone defects at adjacent teeth. The test group received ARP combined with simultaneous PR of adjacent teeth, whereas the control group underwent ARP alone. All sites were managed using an open wound healing protocol. Linear dimensional changes were assessed on superimposed cone-beam computed tomography (CBCT) images obtained preoperatively, immediately postoperatively, and after 6 months of healing. Soft tissue healing was evaluated at the time of suture removal using a standardized open wound healing scoring system.

ARP combined with PR was associated with statistically significant improvements in radiographic interdental bone height over the 6-month healing period. Horizontal ridge width was better preserved in the test group at the crestal and shallow subcrestal levels, with significant intergroup differences observed at 1 mm and 3 mm below the ridge crest. A significant gain in buccal ridge height was observed exclusively in the test group, while vertical ridge height at the lingual/palatal aspect remained basically stable in both groups. Soft tissue healing outcomes were acceptable in both groups; however, the test group presented slightly lower scores in tissue color and total score.

ARP with simultaneous PR in adjacent teeth was associated with improved radiographic interdental bone height and enhanced ridge dimensional stability in defect sockets.