Titanium (Ti) is broadly used for clinical purposes in various medical fields related to bone repair because of its favorable mechanical properties and its ability to osseointegrate in host bone tissue. Nowadays, Ti surfaces can be functionalized in order to provide potentially beneficial additional properties. In this review, we summarize different surface modifications of Ti implants, focusing on biological relevance and the biological issues targeted by each specific approach. We first define the historical relevance of Ti as an implantable material, the osseointegration process, and the main complications related to it before describing the biological rationale which motivates Ti surface modification in implantable devices. Then, we explore a variety of physical and chemical modifications feasible on Ti surfaces. Thereafter, we focus on inorganic and organic coatings being developed for implantable Ti devices that are currently under investigation. Finally, we summarize the surface-modification approaches clinically available or undergoing clinical trials.

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