BACKGROUND: Alveolar ridge preservation (ARP) in molar areas might be effective in minimizing ridge resorption and facilitated implant treatment. The purpose of the systematic review was to evaluate the outcomes of the ARP procedure at molar extraction sites in comparison to spontaneous healing through meta-analysis. MATERIAL AND METHODS: Studies published in PubMed, Embase, Web of Science, Cochrane Central Register of Controlled Trials, and the System for Information on Grey Literature in Europe were searched. Primary outcomes were changes in alveolar ridge width and height. Secondary outcomes included sinus pneumatization and need for additional augmentation at the time of implant placement. RESULTS: A total of 7 studies composing of 4 randomized controlled trials (RCTs), 2 prospective non-randomized clinical trials, and 1 prospective case control study were included. They involved a total of 237 molar extraction sockets from 236 participants. This review revealed that ARP resulted in statistically significant reductions for horizontal changes {mean difference (MD) = 2.21 mm, 95% confidence interval (CI) [0.02, 4.39]}, vertical mid-buccal changes (MD = 1.34 mm, 95% CI [0.85, 1.83]), and vertical mid-lingual changes (MD = 0.96 mm, 95% CI [0.54, 1.38]) when compared with spontaneous healing. The difference in ridge width changes between the two groups was not statistically significant (MD = 1.94 mm, 95% CI [-1.67, 5.55], P = .29) and with substantial heterogeneity (I CONCLUSIONS: ARP is efficacious in reducing socket bone and ridge changes, and minimizing the need for additional augmentation procedures in the molar region. Further well-designed multicenter randomized controlled studies with larger sample size and longer follow-up periods are still needed to further confirm the findings of the current review.