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This study evaluated the clinical, radiographic, and histological outcomes of alveolar ridge preservation (ARP) using collagen sponge with xenografts (CS + Xenografts) versus collagen sponge (CS) alone, compared to spontaneous healing. 36 extraction sockets were randomly allocated into three groups: Group I (CS + Xenografts), Group II (CS alone), and Group III (control) spontaneous healing. Soft tissue assessment and CBCT imaging were conducted before tooth extraction (baseline) and 6 months post-extraction, followed by histologic and histomorphometric analysis of bone biopsies. Groups I and II exhibited minimal vertical and horizontal soft tissue changes compared to the control group (P < 0.001), with no statistically significant difference between Group I and II (P ≥ 0.05). Vertical and horizontal bone resorption was significantly lower in Groups I and II than in the control group (P < 0.001), with no statistically significant difference between Groups I and II regarding vertical bone loss (P = 0.477 and 0.108, respectively); percent of changes were 8.68 ± 2.69 and 8.61 ± 2.14 respectively. The greatest reduction in alveolar bone width was observed at 1 mm: 17.81 ± 3.97 (Group I), 19 ± 2.77 (Group II), and 41.79 ± 10.3 (Group III); overall P < 0.001. Histologically, Group I had the highest area% of lamellar bone and no residual inflammation, followed by Group II, which showed more inflammation; Group III had the lowest area% of lamellar bone. Intervention techniques were clinically and radiographically proven effective in ARP, however, CS + Xenografts histological results showed more lamellar bone and less residual inflammations.