The surface design of titanium implants influences not only the local biological reactions but also affects at least the clinical result in orthopaedic application. During the last decades, strong efforts have been made to improve osteointegration and prevent bacterial adhesion to these surfaces. Following the rule of “smaller, faster, cheaper”, nanotechnology has encountered clinical application. It is evident that the hierarchical implant surface micro- and nanotopography orchestrate the biological cascades of early peri-implant endosseous healing or implant loosening. This review of the literature gives a brief overview of nanostructured titanium-base biomaterials designed to improve osteointegration and prevent from bacterial infection.

The mechanisms of peri-implant de novo bone formation and contact osteogenesis are still largely unknown. In 1984 Donath et al. showed that macrophages were the first cells to colonize a titanium implant. Recently it was shown that that there are inflammatory (M1) and healing macrophages (M2), the latter of which can secrete BMP 2. In the context of data from a gap healing experiment a macrophage model of osseointegration is suggested.