“… 14 , 16 , 17 , 19 , 23 , 44 , 46 , 47 , 49 Taken together, it becomes clear that increasing surface roughness and porosity not only increase the reactive surface area of the biomaterial, but more importantly that osteoblastic cells are able to detect surface topology on a wide nanometer scale range (tens to hundreds of nanometers), and will react differently, according to specific surface parameters. 12 , 14 , 15 , 24 , 44 , 46 , 47 , 49 While a large number of studies suggest that rough titanium surfaces offer a better implant performance compared to smooth titanium surfaces, in part because of their increased surface roughness, ultrahigh values of roughness (R a of 52–74 μm) are not correctly sensed by osteoblastic cells and thus are not compatible with optimal titanium implant performance. 12 , 14–17 , 19 , 23 , 42 , 43 , 54 , 55 Interestingly, osteoclasts (bone-degrading cells), were found to react to smooth and rough titanium surfaces similarly to osteoblasts.…”