Dental implants have become common for restoring function and aesthetics after edentulism, with titanium (Ti) remaining the most widely used material due to its excellent mechanical properties and biocompatibility. Despite their clinical success, long-term performance is strongly influenced by surface characteristics, which regulate osseointegration and susceptibility to bacterial colonisation. Consequently, surface modification approaches have become critical strategies to enhance implant stability, bioactivity and longevity. This review critically evaluates conventional, advanced, and hybrid surface modification strategies. Subtractive methods, such as sandblasting and acid etching, increase microroughness (Ra 1.5–3 μm), enhancing osteoblast attachment and differentiation, but may promote bacterial adhesion and surface contamination. Combined treatments like SLA and SLActive generate hierarchical micro–nano topographies, improving protein adsorption, early-stage osteoblast proliferation (up to 2-fold), and clinical stability. Laser ablation and photofunctionalisation further modulate surface chemistry and wettability, accelerating osseointegration and epithelial cell adhesion. Coating approaches, including layer-by-layer self-assembly, nanospray drying, plasma spraying, and piezoelectric nanocomposites, introduce antimicrobial activity (>95% reduction in Escherichia coli or Staphylococcus aureus) and enhanced osteogenic differentiation with mechanical stability, with adhesion values reaching 49 MPa. Hybrid techniques such as sol–gel, hydrothermal, and anodisation provide controlled topography, chemical composition, and bioactivity, promoting early bone-to-implant contact (BIC increase of 10%–25%) in preclinical models. Notwithstanding promising in vitro and in vivo outcomes, variability in processing parameters and limited standardisation restrict large-scale clinical translation. Overall, contemporary Ti surface engineering emphasises a synergistic balance of topography, chemistry, wettability, and hierarchical structuring to optimise biological performance for dental implant applications.

Chitosan–hydroxyapatite (CS–HA) composite coatings offer a multifunctional surface modification to improve titanium implant performance, combining hydroxyapatite’s osteoconductivity with chitosan’s biocompatibility and antimicrobial properties. This review examines recent in vitro and in vivo studies, noting consistent enhancements in osteoblast adhesion, alkaline phosphatase activity, apatite formation, and bone–implant contact. Incorporation of silver, strontium, or graphene oxide can further boost antibacterial and osteogenic effects. However, variability in coating preparation, substrate treatment, and testing protocols limits reproducibility and clinical extrapolation. Standardised methodologies and extended in vivo validation are essential to advance CS–HA coatings toward reliable dental and orthopaedic applications.