Objective: This study design was cross-sectional analytical. The objective was to compare the radiographic and histological characteristics of the alveolar ridge in partial denture users and orthodontic patients with congenitally missing teeth or those who require tooth extraction as part of their orthodontic treatment, focusing on ridge dimensions, bone density, and tissue health. Methods: One hundred twenty participants were recruited at Rehman College of Dentistry from January 2022 to January 2024. Group 1 included 60 partial denture users, and Group 2 comprised 60 orthodontic patients with congenitally missing teeth or requiring tooth extraction as part of their orthodontic treatment. Radiographic evaluations were conducted using cone-beam computed tomography (CBCT) to assess ridge height, width, bone density, and resorption grades. Bone biopsies were analysed histologically to evaluate cortical thickness, trabecular density, inflammatory activity, and vascularisation. Statistical comparisons were performed using t-tests and chi-square tests, with a significance threshold of p < 0.05. Results: Orthodontic patients exhibited significantly greater alveolar ridge height (10.5 ± 1.2 mm vs. 8.2 ± 1.5 mm, p < 0.001) and width (6.3 ± 0.9 mm vs. 4.5 ± 0.8 mm, p < 0.001) compared to denture users. Bone density was also higher in orthodontic patients (1025 ± 110 HU vs. 780 ± 120 HU, p < 0.001). Histologically, orthodontic patients showed thicker cortical bone (2.5 ± 0.4 mm vs. 1.8 ± 0.3 mm, p < 0.001) and higher trabecular density. Inflammatory markers and vascularisation were notably better in orthodontic patients. These findings highlight significant differences between the two groups' bone quality and ridge health. Conclusion: Partial denture users experience more significant alveolar ridge resorption and compromised bone quality than orthodontic patients. Orthodontic treatment appears to preserve alveolar bone better, underscoring the need for early intervention and tailored treatment strategies. These results provide valuable insights for optimising clinical outcomes in patients with missing teeth.