Purpose: Among all platelet concentrates, platelet-rich fibrin has been shown to possess fibrin, leukocytes, and a variety of growth factors that could promote wound healing. The purpose of this study was to compare the bone healing in natural healing sockets (control group) versus that in sockets under ridge preservation with platelet-rich fibrin alone (test group). Materials and Methods: Searches were conducted via electronic and manual approaches for randomized controlled trials and controlled clinical trials published up to May 2018 that evaluated alveolar ridge outcomes (at least 1-month follow-up) in both natural healing sites and sites with platelet-rich fibrin placement alone for ridge preservation. Changes of ridge height and width, osteoblastic activity, and the number of sites were extracted from original articles for meta-analyses. Weighted mean difference and 95% confidence interval were calculated using a random-effects model. Results: Eight human studies (six randomized controlled trials and two controlled clinical trials) that fulfilled the inclusion criteria were included in the study. Data obtained in the study showed a favorable outcome in platelet-rich fibrin for socket preservation, although the difference was not statistically significant when compared to the natural healing group with regard to alveolar bone height change (weighted mean difference: -0.28 mm, 95% confidence interval: -0.55 to 0.00, P = .051), alveolar bone width change (weighted mean difference: -1.73 mm, 95% confidence interval: -3.58 to 0.12, P = .067), or osteoblastic activity (weighted mean difference: -0.01 [unit], 95% confidence interval: -0.50 to 0.49, P = .982). Conclusion: This study revealed that platelet-rich fibrin alone in ridge preservation does not provide significant additional benefit when compared to natural healing sockets with regard to bone volume, bone density, and osteoblastic activity. Keywords: bone healing, extraction socket, meta-analysis, platelet-rich fibrin, ridge preservation, systematic review