Bacterial Biofilm and Titanium Implants: Mechanisms, Clinical Problems, and Surface Modification Strategies

Bacterial biofilms represent a major clinical challenge, being responsible for the majority of chronic infections and significantly reducing the effectiveness of antibiotic therapy. Their formation on implant surfaces, particularly those made of titanium and its alloys, is strongly associated not only with antimicrobial tolerance but also with persistent, hard-to-eradicate infections, implant loosening or failure, repeated surgical interventions, prolonged hospitalization, and increased morbidity. These complications contribute substantially to the growing problem of antimicrobial resistance and impose significant economic burdens on healthcare systems. This review discusses the mechanisms of biofilm formation, factors influencing bacterial adhesion, and the clinical implications associated with implant-related infections. Special attention is given to titanium-based biomaterials, including conventional Ti-6Al-4V and next-generation alloys such as Ti-13Nb-13Zr, highlighting their advantages and limitations in the context of biocompatibility and susceptibility to biofilm formation. Various strategies for combating biofilms are presented, including physical, chemical, and biological approaches, with emphasis on surface modification techniques. Advanced methods, particularly atomic layer deposition (ALD), are identified as promising solutions for creating uniform, antibacterial coatings, including those based on tin dioxide (SnO₂). Such modifications offer potential for reducing bacterial adhesion, improving osseointegration, and enhancing long-term implant performance.