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PURPOSE: Titanium is a primary metallic biomaterial used in load-bearing orthopedic or dental implants because of its favorable mechanical properties and osseointegration capability. This article reviews the current status of surface optimization techniques for titanium implants, whether such concepts are in the form of sufficiently evidence-based, and highlights the related experimental tools. STUDY SELECTION: A strong emphasis was placed on the enhanced biological responses to titanium implants by modifying the surface finishing process. On this basis, a clear partition of surface chemistry and topography was critical. RESULTS: The intrinsic host tissue response to titanium implants is facilitated by the chemistry or topography of a passive oxide film, although the extent to which the surface characteristics enable rapid osseointegration is still uncertain. CONCLUSION: Besides the fundamental requirements, such as the promotion of osteogenic differentiation, the titanium implant surface should accelerate wound-healing phenomena prior to bone ingrowth toward the surface. Moreover, because initial bacterial attachment to the implant surface is unavoidable, infection control by surface modification is also an important determinant in reducing surgical failure. A desirable surface-biological relationship often needs to be characterized at the nanoscale by means of advanced technologies.
Shibata et al. (Wed,) studied this question.