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Ultra-porous TiO₂ scaffolds are architected non-degradable ceramic graft substitutes, but human evidence relating their structural integration to local tissue maturation remains limited. This exploratory study assessed scaffold-associated healing in a prospective clinical cohort registered at ClinicalTrials.gov (NCT06269497; 10 patients, 11 treated sites). Cone-beam computed tomography (CBCT)-based segmentation at baseline and follow-up was used to quantify changes in bone volume, radiographic low-density/non-mineralized volume, and radiographically detectable scaffold volume. Eleven scaffold-associated specimens were examined using non-decalcified histology, histomorphometry, and immunohistochemistry; nine were retrieved at approximately 6 months, one at 4 months, and one at 9 months. CBCT showed within-site increases in bone and total tissue volume and a reduction in radiographically detectable scaffold volume. Histology showed extensive pore colonization by osteoid-rich tissue, localized mineralization, and limited residual cartilage, consistent with ongoing but incomplete matrix maturation. Normalized RunX2 showed a positive exploratory association with absolute bone volume change, whereas associations with osteocalcin were uncertain and endpoint-dependent. CD206/CD68 and the vessel-to-osteoid ratio were more closely associated with low-density/non-mineralized volume outcomes than with bone-volume change. Osteoclast-associated variables were evaluable in only four sites and were interpreted descriptively. These findings are exploratory and do not establish causality or comparative efficacy, but they characterize tissue-scaffold interactions during human extraction-socket healing. Statement of significance Permanent, highly porous scaffolds are intended to guide tissue growth without being replaced, but human evidence linking scaffold architecture to tissue maturation remains limited. This study combines serial cone-beam computed tomography (CBCT), non-decalcified histology, histomorphometry, and immunohistochemistry to characterize tissue development within an ultra-porous TiO₂ scaffold placed in human extraction sockets. The findings show extensive pore colonization by osteoid-rich tissue containing vascular structures, with localized mineralization and spatially heterogeneous remodeling, immune, and Wnt-regulatory features. The analyses are exploratory and do not establish causality or comparative efficacy; however, they provide human tissue-level data on how a permanent architected ceramic scaffold coexists with regenerating bone. This work supports biomaterials-focused evaluation of scaffold-guided regeneration and informs the design of larger controlled studies.