PURPOSE Granulation tissue containing reactive soft tissue with potential multipotent stem cells can help socket healing following extraction. The aim of this study was to assess bone healing of maxillary large bone defects while maintaining reactive soft tissue. MATERIALS AND METHODS A total of 32 patients presenting large bone defects were selected for this prospective study. Eight patients (Group A) presented with large bone defects but an intact buccal cortical plate, while 24 patients (Group B) presented with large bone defects lacking a buccal cortical plate. Teeth were extracted, and reactive soft tissue was left in the defects. Bone volume was assessed through cone beam computed tomography (CBCT) both before tooth extraction and at 4 months. A histomorphometric evaluation was performed. RESULTS CBCT and cylinder bone cores were obtained for histology and histomorphometry analysis. At 4 months after tooth extraction, CBCT showed bone volume preservation and bone formation and no statistically significant difference in bone volume before and after tooth extraction in group A. However, in group B, over the same time period, a statistically significant increase (P < .01) of vertical bone volume was reported. Biopsy specimens showed the presence of vital bone in the defects 4 months later. CONCLUSION Reactive soft tissue left in large bone defects after tooth extraction may support a significant bone volume gain and vital bone formation.