This study evaluated the efficacy of alveolar ridge preservation (ARP) for pontic site development following non-molar maxillary tooth extraction versus unassisted socket healing (USH). Cone beam computed tomography was employed to measure pre-extraction facial bone thickness (FBT). An ideal baseline pontic was digitally pre-designed according to the characteristics of the site before tooth extraction, which was captured with a surface scanner. Post-extraction pontic modifications were analyzed by superimposing baseline and final scans. Additionally, changes in alveolar ridge width, the presence of a buccal soft tissue concavity, and the need for soft tissue augmentation were also assessed. Among 88 patients, USH sites required significantly more pontic modifications and exhibited greater horizontal ridge reduction compared to sites that underwent ARP (P<.001). ARP sites exhibited a lower prevalence of buccal ridge concavity compared to USH (70.5% vs 88.6%, P=.06) and a lower need for soft tissue augmentation (46.5% vs. 70.5%, P=.06). FBT at baseline was strongly negatively associated with more pontic modifications, greater horizontal ridge reduction, and increased need for soft tissue augmentation regardless of the baseline therapy (P<.001), but not with the presence of a buccal soft tissue concavity (P=.06). These findings suggest that ARP therapy effectively mitigates post-extraction dimensional changes, making it a viable approach for pontic site development. However, ancillary soft tissue augmentation may be required in certain cases to achieve optimal therapeutic outcomes.