This study evaluated the radiographic alterations that occur in immediate postextraction implants and in delayed implants inserted in a preserved ridge. In group A, an implant was placed immediately after tooth extraction, grafting the bone-to-implant gap. In group B, alveolar ridge preservation was performed after tooth extraction, and delayed implant placement was performed 4 months later. The final follow-up was 1 year after prosthetic loading in both groups. The marginal bone level (MBL) was measured at implant insertion (T1), at loading (T2), and at the final follow-up, 12 months after prosthetic loading (T3). At tooth extraction (T0) and T3, the horizontal ridge width (HW) was measured on CBCT scans at three different levels. No statistically significant differences in MBL or HW were found between the two study groups. The outcomes suggest that it is possible to maintain MBL and alveolar bone volumes regardless of whether the procedure is performed through immediate postextraction implant placement or through delayed implant placement in a preserved ridge.