PURPOSE: Regenerative hard or soft tissue augmentation procedures (ReP) are crucial in dental implant therapy. This study evaluates the frequency, timing, and financial implication of these procedures before and after implant placement, alongside the influence of systemic conditions on the need for additional interventions. MATERIALS AND METHODS: This cohort included patients who received implants with or without ReP at the University of Michigan Graduate School of Dentistry from 2011-2023. Data on demographics and systemic health conditions were collected and analyzed using univariable and multivariable logistic regression. RESULTS: 4,803 patients (10,247 implants) were included-48.9% of the patients and 21.7% of the implants received at least one ReP. Ancillary ReP was needed for 14.7% of the implants. The most common of these was alveolar ridge augmentation (ARA) simultaneous with implant placement (42.1%) and alveolar ridge preservation (ARP) (26.4). Diabetics showed significantly higher odds of repeating procedures pre-implant (OR=5.47
p=0.016) and required more frequent hard tissue augmentations post-implant (OR=3.58
p=0.006). Cost analysis revealed that ReP constituted 12.9% of the total implant procedure cost. Notably, the mandibular anterior area was the most likely to undergo ReP (OR=2.08
p=0.001). CONCLUSIONS: One of every two patients received a ReP. Almost half of these patients received ARA (simultaneous or staged), and 1/4 received ARP. Diabetic patients exhibited significantly higher odds of requiring hard tissue augmentation pre-IP and post-IP. Trends showed a shift towards soft tissue augmentation over hard tissue procedures for managing peri-implant deficiencies.