the long-term stability and functionality of medical implants. The selection of a biomaterial is based on its physicochemical properties and the surrounding biological environment. In modern medicine, biomaterials are commonly utilized as fixatives, replacements, and bases for the reconstruction of osseous and dental tissue. [1] Besides the well-known metallic materials such as titanium and its alloys, stainless steel, niobium, tantalum, gold, or cobalt-chromium alloys, [2] the metal-oxide ceramics such as titania or zirconia have become indispensable in dental and bone tissue reconstruction, [3] including prostheses, osteogenic scaffolds, and medically implanted devices to deliver medication, monitor body functions, or provide support to organs and tissues. [4] The feasibility of biomaterials for in vitro applications strongly depends on their chemical composition, surface wettability, roughness, hardness, and stability. The differences in the surface morphology may significantly affect the adhesion and viability of living cells and bacteria, protein adsorption, or differentiation of stem cells and osteoblasts. [5] The precise control of surface topography and properties of a biomaterial is an essential factor for modulating its biological response.To date, several techniques have been developed to create biosurfaces with micro-and nanoscale topographies, striving to enhance the material's biocompatibility. [6] The mechanical roughening enables a random pattern of surface features with various amplitudes and spacings. [7] It is also possible to achieve well-defined and controlled surface features via diverse micro-and nanofabrication techniques such as photolithography, laser machining, or 3D printing. [8][9][10] Additionally, biocompatible surfaces with precisely modeled and controlled topographies at the nanoscale may be synthesized via self-organized electrochemical anodizing of metals. This has proved to be the technically simple, cost-effective, eco-friendly, and versatile approach for creating essential bioceramic materials, such as Al 2 O 3 , TiO 2 , and ZrO 2 , with nanoporous surface morphologies. [11][12][13][14] As an alternative to nanoporous ceramics, metal-oxide protrusions such as nanohillocks, nanopillars, or nanorods, upright-standing and highly aligned on substrates, with Here, zirconium-oxide ceramic coatings comprising arrays of 3D nanostructures are electrochemically synthesized, ranging in shape, size, spacing, and population density, termed as the nanomounds (ø≈65 nm), nanopillars (ø≈130 nm), and nanostumps (ø≈220 nm). The nanostructured coatings, alongside a flat ZrO 2 anodic film, are explored as a potential biomaterial in experiments with Saos-2 cells. All coatings reveal no cytotoxicity to living cells. The population density and spreading area of the cells, being the largest on the flat film, slightly decrease with increasing nanostructure dimensions. The cells progressively proliferate on all the surfaces, the nanomounds and, especially, nanopillars promoting the best viabilities and...