Nanofeatured Titanium Surfaces for Dental Implants: A Systematic Evaluation of Osseointegration

Whether nanoengineered titanium surfaces confer superior implant stability beyond modern microrough controls remains uncertain.

This systematic review followed PRISMA 2020 guidance: comprehensive multi-database searching with de-duplication; dual independent screening, full-text assessment, and standardized data extraction for predefined outcomes (implant stability quotient [ISQ], mechanical anchorage by removal/push-out/pull-out torque, and histologic bone-to-implant contact). Risk of bias was appraised with RoB 2 for randomized trials, ROBINS-I for non-randomized clinical studies, and CAMARADES (animal experimentation). The certainty of clinical evidence was summarized using GRADE.

Across animal models, nanoengineered surfaces consistently improved early osseointegration indices (higher removal torque and bone-to-implant contact at initial healing). In clinical comparative studies, nanoengineered implants showed modest, time-limited gains in early stability (ISQ) versus microrough titanium. By 3-6 months, between-group differences typically diminished, and no consistent advantages were demonstrated for survival or marginal bone outcomes at later follow-up. Methodologic heterogeneity (surface chemistries, timepoints, outcome definitions) and small clinical samples limited quantitative synthesis. Overall, risk-of-bias concerns ranged from some concerns to high in non-randomized studies; the certainty of clinical evidence was low.

Nanofeatured titanium surfaces improve early osseointegration but do not demonstrate a consistent long-term advantage over modern microrough implants. Current evidence supports an early osseointegration benefit without clear long-term clinical advantage over contemporary microrough implants. Adequately powered, head-to-head trials with standardized stability endpoints and ≥12-month follow-up are needed to determine whether early gains translate into patient-important outcomes.