Can We Further Improve Titanium Implant Surfaces at Nanoscale to Enhance Osseointegration?

The main aim of this review study was to report the state of art on the technological improvements of titanium implant surfaces to accelerate the osseointegration process.Several methods of surface modification are chronologically described bridging ordinary methods (e.g. grit blasting and etching) and novel physicochemical approaches such as 3D-laser printing and biomimetic modification. Advanced functionalization procedures by using proteins, peptides, and bioactive ceramics have provided an enhancement of wettability and bioactivity of implant surfaces. Furthermore, recent findings have revealed a combined beneficial effect of micro- and nano-scale modification and biomimetic functionalization of titanium surfaces. However, some technological developments of implant surfaces are not commercially available yet due to costs and a lack of clinical validation of the novel surfaces. Further in vitro and in vivo studies are necessary to endorse of the use of enhanced biomimetic implant surfaces.