The fast evolution of surface treatments for biomedical implants and the concern with their contact with cells and microorganisms at early phases of bone healing has boosted the development of surface topographies presenting drug delivery potential for, among other features, bacterial growth inhibition without impairing cell adhesion. A diverse set of metal ions and nanoparticles (NPs) present antibacterial properties of their own, which can be applied to improve the implant local response to contamination. Considering the promising combination of nanostructured surfaces with antibacterial materials, this critical review describes a variety of antibacterial effects attributed to specific metals, ions and their combinations. Also, it explains the TiO2 nanotubes (TNTs) surface creation, in which the possibility of aggregation of an active drug delivery system is applicable. Also, we discuss the pertinent literature related to the state of the art of drug incorporation of NPs with antibacterial properties inside TNTs, along with the promising future perspectives of in situ drug delivery systems aggregated to biomedical implants.

Marcel Ferreira Kunrath, DDS, MSc, PhD/Renata Piassarollo dos Santos, DDS/S?lvia Dias de Oliveira, MSc, PhD/Roberto Hubler, MSc, PhD/Patr?cia Sesterheim, MSc, PhD/Eduardo Rolim Teixeira, DDS, PhD: Purpose: Surface treatments may significantly affect physical-chemical properties and surface biologic responses. This study aimed to investigate the influence of alterations in the physical-chemical properties of pure titanium with different surface topographies on biocompatibility and early microbiologic response. Materials and Methods: Titanium disks were exposed to five different surface treatments created through acid etching and anodizing methods. Surface morphology, 2D and 3D roughness, wettability, biocompatibility, and cell viability were evaluated. Osteoblast adhesion and bacterial adhesion tests were also executed. Data were statistically analyzed using analysis of variance followed by Tukey test, roughness (P < .05), and bacterial proliferation (P < .05). Results: Five different surface morphologies were developed; double acid etching was shown to be significantly rougher than the others. The 2D roughness measurements were shown to be less consistent than the 3D measurements. All surfaces presented biocompatibility to allow cell behavior and differentiation. Osteoblasts presented better evolution in terms of adhesion and behavior in the nanomorphologies. High roughness significantly increased bacterial adhesion. Conclusion: Surface treatments may critically alter titanium properties and morphology. Therefore, roughness measurements with a wide area should be used in their evaluation. Nanotextured surfaces show a positive effect on bone cells and antibacterial response; their application is suggested when considering surface texturization for biomedical implants.