The surface characteristics of a calcium ion (Ca)-incorporated titanium (Ti) surface, produced by hydrothermal treatment using an alkaline Ca-containing solution, and its effects on osteoblastic differentiation were investigated. MC3T3-E1 pre-osteoblastic cells were cultured on machined or grit-blasted Ti surfaces with and without Ca incorporation. The MTT assay was used to determine cell proliferation, and real-time PCR was used for quantitative analysis of osteoblastic gene expression. Hydrothermal treatment with a Ca-containing solution produced a crystalline CaTiO(3) nanostructure of approximately 100 nm in dimension, preserving original micron-scaled surface topographies and microroughness caused by machining, blasting, or blasting and etching treatments. After immersion in Hank's balanced salt solution, considerable apatite formation was observed on all surfaces of the Ca-incorporated samples. Significantly more cell proliferation was found on Ca-incorporated Ti surfaces than on untreated Ti surfaces (p < 0.001). Quantitative real-time PCR analysis showed notably higher alkaline phosphatase, osteopontin, and osteocalcin mRNA levels in cells grown on Ca-incorporated blasted surfaces than on other surfaces at an early time point. Thus, Ca incorporation may have a beneficial effect on osseointegration of microstructured Ti implants by accelerating osteoblast proliferation and differentiation during the early healing phase following implantation.