Next-generation dental implant surface modifications for osseointegration: From nanoengineering to clinical...

This narrative review, prepared in accordance with the Scale for the Assessment of Narrative Review Articles, surveys next-generation dental implant surface modifications for osseointegration, from nanoengineering to clinical translation. Peri-implantitis affects approximately 19.53% of patients and 12.53% of implants. Because peri-implant tissue destruction reflects a dysregulated host inflammatory response to an unavoidable, lifelong microbial challenge rather than bacterial colonization alone, the design target is shifting from surfaces that are simply bactericidal to surfaces that regulate inflammation while supporting bone integration. Surface design has evolved from machined titanium through sandblasted and acid-etched (SLA) platforms and the superhydrophilic SLActive surface to nanoengineered, bioactive, and stimuli-responsive architectures. SLActive surfaces prevent hydrocarbon adsorption so that near-zero water contact angles are retained, whereas unprotected SLA surfaces progressively lose hydrophilicity with storage time. Electrochemically anodized titanium dioxide nanotube arrays elicit diameter-dependent cellular responses. Tubes with diameters of 70 to 100 nm drive approximately 10-fold elongation of mesenchymal stem cells and selective osteogenic differentiation and enhance bone bonding 9-fold in vivo. Bioactive coatings incorporating nanostructured hydroxyapatite, therapeutic ion-doped bioactive glasses (niobium, cerium, and zinc), and immobilized growth factors such as bone morphogenetic protein 2 and vascular endothelial growth factor actively direct cellular behavior. Antimicrobial strategies, including silver nanoparticles, antimicrobial peptides (GL13K and HHC-36), and photodynamic or photothermal therapies, address microbial colonization while preserving osteogenic potential. However, ensuring lifelong efficacy remains the key challenge for any release-based approach. Stimuli-responsive systems employ pH-responsive gating, zeolitic imidazolate framework-8 metal-organic framework carriers, and enzyme-cleavable linkers to enable microenvironment-triggered release. Additive manufacturing advances, including triply periodic minimal surface lattices and four-dimensional (4D)-printed shape-memory nickel-titanium constructs, enable patient-specific geometries with tailored porosity gradients. In contrast, femtosecond laser texturing, plasma treatments, and atomic layer deposition provide atomic- to micro-scale control. Emerging graphene oxide derivatives, modified polyetheretherketone, and zirconia-based ceramics further broaden the design landscape. Despite robust preclinical evidence, translational progress remains constrained by regulatory complexity, manufacturing scalability, and limited long-term clinical data. Herein, we synthesize preclinical and clinical evidence, identify research gaps, propose artificial intelligence-guided design directions, and outline pathways for translating next-generation surfaces into routine practice. We explicitly outline the limitations inherent to a narrative synthesis.