This study aimed to collectively synthesize the available evidence on the effect of alveolar ridge preservation at the posterior maxilla in reducing maxillary sinus pneumatization after tooth extraction, and the necessity of sinus floor augmentation during implant placement. Database search, along with additional screening in the grey literature were conducted, to find clinical studies where ridge preservation was performed in the posterior maxilla, and was compared with normal healing. Eleven studies were included, with 185 and 203 sites for the test and control groups, respectively. Ridge preservation significantly decreased sinus pneumatization (SMD = - 0.88, 95% CI - 1.19 to - 0.58, p-value < 0.00001) and reduced the need for additional sinus floor augmentation when placing dental implants (OR = 0.18, 95% CI 0.09 to 0.36, p-value < 0.00001). Moreover, ridge height was significantly greater (SMD = 1.33, 95% CI 0.58 to 2.09, p-value = 0.0005), while ridge width did not show a statistical significance, compared to spontaneous healing (p-value = 0.053). Therefore, alveolar ridge preservation in the posterior maxilla decreases sinus pneumatization, as well as the need for sinus floor augmentation at the time of implant placement, along with its general benefits in preserving bone volume. Nevertheless, future comparisons are still needed, considering the small number of studies available.