Jul 2026· Journal of Periodontal Research· 0 citations· 269 references
Medicine
TL;DR
The mechanobiological principles governing host-implant interactions are examined and current strategies for engineering multifunctional antimicrobial, immunomodulatory, and regenerative implant surfaces represent a promising strategy for improving long-term implant integration and peri-implant tissue health.
Abstract
Dental implants rely on a stable and functional interface between the implant surface, surrounding tissues, and the oral microbial environment. While titanium remains the clinical gold standard due to its mechanical properties and capacity for osseointegration, peri-implant inflammation and biofilm-associated infection continue to compromise long-term outcomes. Consequently, there is growing interest in multifunctional implant surfaces capable of simultaneously regulating microbial colonisation, immune responses and peri-implant tissue integration. Advances in surface engineering and biomaterials science have revealed that implant surface chemistry and micro- and nanoscale topography strongly influence protein adsorption, immune activation, cellular behaviour, and bacterial attachment at the host-implant interface. Inspired by naturally antimicrobial and self-cleaning biological surfaces, biomimetic approaches have led to the development of mechano-bactericidal nanostructured titanium interfaces capable of physically inactivating bacteria while maintaining cytocompatibility and enhancing osteogenesis. This review examines the mechanobiological principles governing host-implant interactions and examines current strategies for engineering multifunctional antimicrobial, immunomodulatory, and regenerative implant surfaces. The translational challenges limiting clinical implementation, including mechanical durability, biological masking of engineered surfaces and long-term functional stability, are also discussed, together with emerging interest in alternative implant materials such as zirconia. Collectively, biomimetic multifunctional implant surfaces represent a promising strategy for improving long-term implant integration and peri-implant tissue health, although further translational and clinical validation remains necessary before widespread clinical adoption.
Implant-associated infections (IAIs) persist as a critical complication in biomaterial transplantation, driven by rapid microbial colonization, biofilm encapsulation, and escalating antibiotic resistance. Conventional antibiotic-based treatments and passive antimicrobial coatings often fail to achieve long-term infection control due to limited biofilm penetration, localized cytotoxicity, and active agent depletion. To overcome these limitations, piezoelectric nanocomposite coatings utilize a dynamic, stimulus-responsive framework that converts physiological mechanical forces or external ultrasound into localized electrical signals. These surface-bound electric fields systematically mitigate bacterial adhesion, eradicate mature biofilms via targeted reactive oxygen species (ROS) generation, disrupt microbial metabolic pathways, and favorably modulate the peri-implant immune microenvironment while supporting host tissue repair. This review evaluates the material design principles and classifications of inorganic, organic, and hybrid piezoelectric nanocoatings. We detail their multifaceted antibacterial mechanisms and trace their therapeutic potential in orthopedic and dental implants, as well as wound management. Lastly, we analyze current engineering bottlenecks to chart a clear trajectory for their clinical translation.
PURPOSE
Peri-implantitis is a major biological complication in implant dentistry, associated with bacterial biofilm formation and amplified by dysregulated host immune responses. Increasing evidence indicates that implant and abutment surface properties influence not only osseointegration but also microbial retention, soft-tissue sealing, and innate immune cell behavior. This narrative review aimed to summarize the current evidence on how dental implant nanotopography may affect peri-implantitis-related biological responses, with particular emphasis on innate immunity, region-specific peri-implant biointerfaces, and peri-implant tissue stability.
METHODS
Clinical, animal, and in vitro studies were reviewed to examine the pathogenesis of peri-implantitis, the roles of innate immune cells, the influence of implant and abutment surface topography on microbial and immune responses, and emerging nano-enabled strategies for the active regulation of peri-implant tissue responses.
RESULTS
Peri-implantitis progression is shaped by the interplay among the disruption of transmucosal soft-tissue sealing, microbial invasion, implant- or abutment-derived foreign-body stimuli, and sustained dysregulated innate immune activation. Nanotopographic surfaces regulate epithelial and fibroblastic attachment, extracellular matrix organization, neutrophil and macrophage responses, and osteocyte network formation via mechanotransduction. The biological effects of nanotopography are design-dependent and are influenced by nanoscale geometry, size, hydrophilicity, and associated physicochemical properties, including surface chemistry, wettability, and charge. Additionally, anisotropic nanospike surfaces and nano-enabled biomolecule delivery technologies illustrate the future possibility of active nanointerface regulation beyond conventional surface modification, although intracellular delivery technologies currently remain conceptual for dental implant applications.
CONCLUSIONS
Implant and abutment nanotopography may contribute to peri-implant tissue stability by coordinating soft-tissue sealing, microbial retention control, innate immune calibration, and bone-interface resilience. Although direct clinical evidence remains limited, region-specific and functionally active nano-biointerfaces may offer new opportunities to reduce susceptibility to peri-implant inflammatory tissue breakdown.
T. Kondo, Masahiro Yamada, S. Ambo et al.· International Journal of Imp...· 0 citations
Orthopedic metal implants are central to fracture fixation, bone‐defect reconstruction, and joint replacement, but their long‐term performance remains limited by implant‐associated infection, biofilm persistence, foreign body response, and impaired osseointegration. This review reframes antibacterial and immunomodulatory coatings as regulators of a dynamic implant biointerface rather than as isolated bactericidal or drug‐eluting layers. We first outline the biological coupling among protein conditioning, bacterial adhesion, biofilm maturation, macrophage‐mediated inflammation, corrosion, surface topography, and bone integration. We then summarize design requirements for orthopedic metal implant coatings, including cytocompatibility, anti‐biofilm efficacy, immune balance, osteogenic support, mechanical adhesion, wear durability, and electrochemical stability. Antibacterial strategies are discussed according to ion‐releasing and metal oxide coatings, bioceramic and bioactive glass‐based systems, antimicrobial cargo delivery, contact‐killing and anti‐adhesive surfaces, and externally activated responsive coatings. Immunomodulatory strategies are organized around local anti‐inflammatory delivery, natural molecules, cytokine or growth factor presentation, ion‐mediated osteoimmunomodulation, and redox or thermal regulation. Finally, we highlight multifunctional coating architectures, fabrication‐dependent structure–function relationships, integrated validation frameworks, and translational barriers. This Review provides a design‐oriented framework for developing clinically translatable orthopedic implant interfaces that coordinate infection control, immune regulation, osseointegration, and long‐term stability.
Z. Mao, Chuanyao Dong, Yifan Jia et al.· Advanced Healthcare Material...· 0 citations
Titanium implants are widely used in orthopedic surgery due to their excellent biocompatibility and mechanical properties. However, their long-term clinical success is often limited by complications such as postoperative infection, chronic inflammation, and inadequate osseointegration. In recent years, hydrogels have been extensively explored for tissue regeneration because of their biological activity and functional versatility. One emerging application is the surface modification of titanium implants, in which hydrogel coatings can be engineered to improve implant adaptability and osseointegration under complex pathological conditions. This review summarizes the classification, fabrication methods, stimuli-responsive features, and emerging bone-regenerative applications of hydrogel coatings on titanium implants. We also discuss the prospects and challenges of functionalized hydrogel coatings for titanium implants in clinical translation. By examining the latest advances in this rapidly evolving research area, the review aims to catalyze innovation in implant-based bone repair and therapeutic applications.
Aoao Wang, Zebin Gui, Li Ruan et al.· Bioactive Materials· 0 citations
Introduction
Dental implant therapy has become a predictable and widely accepted treatment modality for the restoration of oral function and aesthetics. Despite high long-term survival rates, biological complications such as peri-implant mucositis and peri-implantitis remain significant challenges that may compromise implant stability and patient quality of life. Implant surface characteristics play a crucial role in both osseointegration and microbial colonization, creating a complex balance between enhanced bone integration and resistance to biofilm formation. This narrative review aims to provide a comprehensive overview of current strategies in dental implant surface engineering with regard to their dual role in promoting osseointegration and preventing peri-implant diseases.
Materials and Methods
Literature published between 2020 and 2025 was analyzed using PubMed, Scopus, and Web of Science databases.
Results
The review discusses the influence of surface topography, roughness, chemistry, and wettability on biological responses at the implant interface. Furthermore, contemporary modification strategies, including bioactive ceramic coatings, ion and nanoparticle incorporation, nanotopography, anodization, and laser surface treatments, are critically evaluated. Emerging multifunctional approaches combining osteogenic and antimicrobial properties are also highlighted.
Conclusions
Current evidence suggests that no single surface modification fully optimizes both osseointegration and bacterial resistance. However, advanced nanostructured and laser-modified surfaces demonstrate promising potential for improving long-term implant performance. Future progress in implantology will likely depend on integrating biomaterial innovations with individualized clinical approaches and long-term evidence-based evaluation.
Aleksandra Jędras, Gabriela Czerepak, Weronika Pociask et al.· Quality in Sport· 0 citations
The multifunctional coating provides sustained antimicrobial activity alongside immunomodulatory and pro-regenerative effects, supporting its potential to treat implant-related infections while enhancing peri-implant soft tissue remodeling.
Mariana Martins Guerreiro, Amanda Paino Santana, D. M. Cunha et al.· Journal of Periodontal Resea...· 0 citations