Dental implants are a known and predictable treatment option for missing teeth, where most patients today desire this therapy. However, our patients often lack adequate bone and soft tissue to facilitate ideal implant placement, which can compromise long-term function and esthetics. In recent years, increasing evidence is available outlining the importance of systemic health and environmental factors on hard and soft tissue regeneration, as well as implant survival and success. These patient factors pose difficulties for clinicians, especially as patients are becoming more demanding for immediate implant placement, immediate restoration delivery, and simultaneous grafting and implant procedures. How do clinicians manage the challenge of meeting patient demands as our patients themselves become more medically compromised? Can we deny surgical procedures to patients who smoke or take medications that are known to inhibit wound healing? We must ensure that patients are first optimized before undergoing complex regenerative procedures and make them aware of relevant systemic and environmental conditions that may prevent predictable outcomes. This presentation will update the practicing clinician on achieving successful regenerative outcomes, while avoiding and managing complications in compromised patients.