<p>This randomized controlled trial evaluated the efficacy of titanium-prepared platelet-rich fibrin (T-PRF) for alveolar ridge preservation (ARP) compared with leukocyte and platelet rich fibrin (L-PRF) and spontaneous healing. Thirty single-rooted teeth requiring extraction were randomly assigned to one of three groups (ARP with T-PRF, ARP with L-PRF, and spontaneous healing) using a flapless, atraumatic extraction approach. Radiographic measurements (bone width, height, and density) were obtained pre-operatively and at four months via OnDemand3D software, and clinical parameters—including post-operative pain, analgesic consumption, soft-tissue healing, periodontal probing depth, gingival recession, and keratinized tissue width—were assessed. At four months, the T-PRF group demonstrated substantially greater preservation of ridge dimensions (<i>P</i> = 0.000), and higher bone density (<i>P</i> = 0.000), along with improved soft-tissue healing (<i>P</i> &lt; 0.05), lower pain scores (<i>P</i> = 0.000), and reduced analgesic use (<i>P</i> &lt; 0.05). Periodontal parameters remained stable across the groups, except for keratinized tissue width (KTW), which was substantially greater in the T-PRF group (<i>P</i> = 0.020). There were substantial differences among the groups in the need for bone regeneration when implants were placed (<i>P</i> &lt; 0.05). These findings support the clinical advantage of T-PRF in optimizing post-extraction outcomes for implant site development.</p><p>This trial was registered in the UK’s Clinical Study Registry ISRCTN (ISRCTN60191547).</p>