Background: Orthodontic tooth extraction is a common procedure that can lead to alveolar defects impacting treatment outcomes. Understanding the healing process and the effects on alveolar bone structure is crucial for effective orthodontic planning. This study compares the impact of Periotome luxation and intra-alveolar extraction on buccal cortical plate thickness, lingual cortical plate thickness, and total alveolar width, crucial parameters for successful orthodontic treatment. Method: An in-vivo comparative analysis was conducted on 11 patients undergoing orthodontic treatment involving mandibular first premolar extraction. Periotome luxation and intra-alveolar extraction procedures were performed, and CBCT scans were taken pre-treatment, at 3 months, and 6 months post-extraction. Measurements of buccal and lingual cortical thickness and total alveolar width were obtained at various distances from the cement-enamel junction (CEJ). Result: The results reveal significant decreases in buccal and lingual cortical thickness and total alveolar width over time for both extraction methods. Notably, intra-alveolar extraction showed more pronounced reductions in lingual cortical thickness at the CEJ. However, Periotome luxation demonstrated better preservation of total alveolar width at the CEJ compared to intra-alveolar extraction. Conclusion: Periotome luxation appears to be a more conservative approach, preserving total alveolar width and minimizing lingual cortical thickness reduction compared to intra-alveolar extraction. These findings underscore the importance of extraction method selection in orthodontic planning for optimal treatment outcomes.