Regenerative Surface Engineering of Dental Implants: Biological Strategies and Translational Perspectives

Improvements in early biological responses to engineered dental implant surfaces have not consistently translated into superior long-term survival, marginal bone stability, or prevention of peri-implant disease relative to contemporary surfaces. This narrative review focuses on titanium implants and abutments, examining six complementary strategies: osseointegration, soft-tissue integration, antibacterial activity, osteoimmunomodulation, periodontal ligament regeneration, and multifunctional and smart surfaces. It evaluates their biological rationale alongside the preclinical and clinical evidence supporting their use. Experimental studies demonstrate changes in cell attachment, bone formation, microbial control, and immune regulation, while responsive systems coordinate these functions through controlled release or activation. Most emerging approaches remain supported predominantly by preclinical evidence. Future development should match surface functions to the requirements of each implant region and healing stage. Clinical translation requires reproducible performance and comparative studies demonstrating benefits in patient-relevant outcomes, including loading safety, tissue stability, and long-term maintainability.