Bacterial infections of medical devices present severe problems connected with long-term antibiotic treatment, implant failure, and high hospital costs. Therefore, there are enormous demands for innovative techniques which would improve the surface properties of implantable materials. Plasma technologies present one of the compelling ways to improve metal’s antibacterial activity; plasma treatment can significantly alter metal surfaces’ physicochemical properties, such as surface chemistry, roughness, wettability, surface charge, and crystallinity, which all play an important role in the biological response of medical materials. Herein, the most common plasma treatment techniques like plasma spraying, plasma immersion ion implantation, plasma vapor deposition, and plasma electrolytic oxidation as well as novel approaches based on gaseous plasma treatment of surfaces are gathered and presented. The latest results of different surface modification approaches and their influence on metals’ antibacterial surface properties are presented and critically discussed. The mechanisms involved in bactericidal effects of plasma-treated surfaces are discussed and novel results of surface modification of metal materials by highly reactive oxygen plasma are presented.

In this review, strategies for improving the antimicrobial properties of stainless steel (SS) are presented. The main focus given is to present current strategies for surface modification of SS, which alter surface characteristics in terms of surface chemistry, topography and wettability/surface charge, without influencing the bulk attributes of the material. As SS exhibits excellent mechanical properties and satisfactory biocompatibility, it is one of the most frequently used materials in medical applications. It is widely used as a material for fabricating orthopedic prosthesis, cardiovascular stents/valves and recently also for three dimensional (3D) printing of custom made implants. Despite its good mechanical properties, SS lacks desired biofunctionality, which makes it prone to bacterial adhesion and biofilm formation. Due to increased resistance of bacteria to antibiotics, it is imperative to achieve antibacterial properties of implants. Thus, many different approaches were proposed and are discussed herein. Emphasis is given on novel approaches based on treatment with highly reactive plasma, which may alter SS topography, chemistry and wettability under appropriate treatment conditions. This review aims to present and critically discuss different approaches and propose novel possibilities for surface modification of SS by using highly reactive gaseous plasma in order to obtain a desired biological response.

The fluorination of the polymer polyethylene terephthalate in plasma created from SF₆ or CF₄ gas at various pressures was investigated. The surface was analysed by X-ray photoelectron spectroscopy and water contact angle measurements, whereas the plasma was characterized by optical emission spectroscopy. The extent of the polymer surface fluorination was dependent on the pressure. Up to a threshold pressure, the amount of fluorine on the polymer surface and the surface hydrophobicity were similar, which was explained by the full dissociation of the SF₆ and CF₄ gases, leading to high concentrations of fluorine radicals in the plasma and thus causing the saturation of the polymer surface with fluorine functional groups. Above the threshold pressure, the amount of fluorine on the polymer surface significantly decreased, whereas the oxygen concentration increased, leading to the formation of the hydrophilic surface. This effect, which was more pronounced for the SF₆ plasma, was explained by the electronegativity of both gases.

In our study, plasma surface modification was employed to tailor the surface properties of magnesium in terms of surface chemistry, topography, and wettability. For two sets of samples, the plasma treatment involved two steps using two different gases (hydrogen and oxygen), while one set of samples was treated with one step only using oxygen. X-ray photoelectron spectroscopy (XPS) was applied to determine the surface composition, oxidation state of the elements, and the thickness of the surface oxide layer on the Mg samples after different plasma treatments. The surface morphology was characterised using atomic force microscopy (AFM) and scanning electron microscopy (SEM). The wettability was analysed by measuring the static water-contact angles and the corrosion was evaluated using potentiodynamic measurements. The interaction of the live cells with the differently modified Mg surfaces was evaluated in terms of biocompatibility using MG-63 cells (human bone osteosarcoma cells). We have shown that a plasma surface treatment significantly decreased the carbon content and the formation of a 15–20-nm-thick MgO layer was observed. This improves the corrosion resistance, while the biocompatibility was retained, compared to the untreated Mg. A plasma surface treatment is therefore an important step in the development of novel surfaces with improved corrosion resistance for magnesium in biomedical applications.

Samples of polymer polyethylene terephthalate were exposed to a weakly ionized gaseous plasma to modify the polymer surface properties for better cell cultivation. The gases used for treatment were sulfur dioxide and oxygen of various partial pressures. Plasma was created by an electrodeless radio frequency discharge at a total pressure of 60 Pa. X-ray photoelectron spectroscopy showed weak functionalization of the samples’ surfaces with the sulfur, with a concentration around 2.5 at %, whereas the oxygen concentration remained at the level of untreated samples, except when the gas mixture with oxygen concentration above 90% was used. Atomic force microscopy revealed highly altered morphology of plasma-treated samples; however, at high oxygen partial pressures this morphology vanished. The samples were then incubated with human umbilical vein endothelial cells. Biological tests to determine endothelialization and possible toxicity of the plasma-treated polyethylene terephthalate samples were performed. Cell metabolic activity (MTT) and in vitro toxic effects of unknown compounds (TOX) were assayed to determine the biocompatibility of the treated substrates. The biocompatibility demonstrated a well-pronounced maximum versus gas composition which correlated well with development of the surface morphology.