Surface Modification Of Implants Research Articles

From surface to success: How implant surfaces shape osseointegration

The field of dental implantology has significantly advanced to address the multifaceted impacts of tooth loss, encompassing physical, functional, emotional, psychological, and social dimensions. Dental implants serve as reliable solutions, ensuring stability, minimal bone loss, and absence of pain or infection. Central to their success is the surface modification of implants, which profoundly influences osseointegration—the process crucial for establishing a functional bond between bone and implant. This review explores various physical modifications of dental implant surfaces, focusing on macro, micro, and nano-level alterations. Macro-level modifications optimize implant geometry and thread design to enhance initial stability and long-term fixation. Micro-level modifications, including grit blasting and acid etching, increase surface roughness to facilitate mechanical interlocking and cell adhesion. Nano-level modifications, such as hydrophilic coatings and bioceramic enhancements, enhance surface energy and promote osteoblastic differentiation, thereby accelerating osseointegration. These surface modifications represent a critical frontier in implant dentistry, promising improved clinical outcomes and patient satisfaction through enhanced integration and reduced healing times.

Variations of chemical, physical, mechanical properties, and biological and antimicrobial effectiveness of Ti alloys by coating with CaP doped with different amounts of Zn via micro-arc oxidation (MAO) technique

Titanium alloys are preferred metals as implant materials due to their advantageous combination of low density and high biocompatibility. However, the augmentation of implant surfaces with calcium-based coatings becomes essential to regulate corrosion rates and enhance the osteoconductive properties of the implant material. In this study, titanium alloys, specifically Ti6Al4V, underwent a transformative process wherein they were coated with calcium phosphate (CaP) ceramics doped with zinc (Zn) via micro-arc oxidation (MAO) technique, using varying concentrations of Zn compound in the electrolyte solutions. The chemical and physical properties of the freshly prepared samples were analyzed, both initially and after culturing them with Saos-2 cells. Furthermore, the antimicrobial efficacy against E. coli was examined. The findings unveiled the remarkable efficiency of the MAO technique in forming an uniformly distributed coat on Ti6Al4V, thereby enhancing its mechanical resilience and biocompatibility, depending upon the preparation parameters employed. It was shown that Zn doped calcium coating is very efficient to regulate various parameters such as corrosion rate and mechanical strength, and an increase in Zn content exhibited a favorable impact on cell attachment and antimicrobial efficacy. Surface modification of metallic implants via MAO technique can be applied in the production of advanced implant materials.

On the Use of Nanoparticles in Dental Implants.

Results obtained in physics, chemistry and materials science on nanoparticles have drawn significant interest in the use of nanostructures on dental implants. The main focus concerns nanoscale surface modifications of titanium-based dental implants in order to increase the surface roughness and provide a better bone-implant interfacial area. Surface coatings via the sol-gel process ensure the deposition of a homogeneous layer of nanoparticles or mixtures of nanoparticles on the titanium substrate. Nanotubular structures created on the titanium surface by anodic oxidation yield an interesting nanotopography for drug release. Carbon-based nanomaterials hold great promise in the field of dentistry on account of their outstanding mechanical properties and their structural characteristics. Carbon nanomaterials that include carbon nanotubes, graphene and its derivatives (graphene oxide and graphene quantum dots) can be used as coatings of the implant surface. Their antibacterial properties as well as their ability to be functionalized with adequate chemical groups make them particularly useful for improving biocompatibility and promoting osseointegration. Nevertheless, an evaluation of their possible toxicity is required before being exploited in clinical trials.

Enhancing the Biological Performance of Titanium Alloy through In Situ Modulation of the Surface Nanostructure: Near-Infrared-Responsive Antibacterial Function and Osteoinductivity.

The poor clinical performance of titanium and its alloy implants is mainly attributed to their lack of antibacterial ability and poor osseointegration. The key and challenge lie in how to enhance their osteoinductivity while imparting antibacterial capability. In this study, a titanium oxide metasurface with light-responsive behavior was constructed on the surface of titanium alloy using an alkaline-acid bidirectional hydrothermal method. The effects of the acid type, acid concentration, hydrothermal time, hydrothermal temperature, and subsequent heat treatments on the optical behavior of the metasurface were systematically investigated with a focus on exploring the influence of the metasurface and photodynamic reaction on the osteogenic activity of osteoblasts. Results show that the type of acid and heat treatment significantly affect the light absorption of the titanium alloy surface, with HCl and post-heat-treatment favoring redshift in the light absorption. Under 808 nm near-infrared (NIR) irradiation for 10 min, in vitro antibacterial experiments demonstrate that the antibacterial rate of the metasurface titanium alloy against Staphylococcus aureus and Escherichia coli were 96.87% and 99.27%, respectively. In vitro cell experiments demonstrate that the nanostructure facilitates cell adhesion, proliferation, differentiation, and expression of osteogenic-related genes. Surprisingly, the nanostructure promoted the expression of relevant osteogenic genes of MC3T3-E1 under 808 nm NIR irradiation. This study provides a method for the surface modification of titanium alloy implants.

SrTiO3 Nanotube-Based "Pneumatic Nanocannon" for On-Demand Delivery of Antibacterial and Sustained Osseointegration Enhancement.

Infection and aseptic loosening caused by bacteria and poor osseointegration remain serious challenges for orthopedic implants. The advanced surface modification of implants is an effective strategy for addressing these challenges. This study presents a "pneumatic nanocannon" coating for titanium orthopedic implants to achieve on-demand release of antibacterial and sustained release of osteogenic agents. SrTiO3 nanotubes (SrNT) were constructed on the surface of Ti implants as "cannon barrel," the "cannonball" (antibiotic) and "propellant" (NH4HCO3) were codeposited into SrNT with assistance of mussel-inspired copolymerization of dopamine and subsequently sealed by a layer of polydopamine. The encapsulated NH4HCO3 within the nanotubes could be thermally decomposed into gases under near-infrared irradiation, propelling the on-demand delivery of antibiotics. This coating demonstrated significant efficacy in eliminating typical pathogenic bacteria both in planktonic and biofilm forms. Additionally, this coating exhibited a continuous release of strontium ions, which significantly enhanced the osteogenic differentiation of preosteoblasts. In an implant-associated infection rat model, this coating demonstrated substantial antibacterial efficiency (>99%) and significant promotion of osseointegration, along with alleviated postoperative inflammation. This pneumatic nanocannon coating presents a promising approach to achieving on-demand infection inhibition and sustained osseointegration enhancement for titanium orthopedic implants.

Investigation of a new implant surface modification using phosphorylated pullulan.

Various implant surface treatment methods have been developed to achieve good osseointegration in implant treatment. However, some cases remain impossible to treat with implants because osseointegration is not obtained after implantation, and the implants fail. Thus, this study focused on phosphorylated pullulan because of its adhesiveness to titanium (Ti) and bone, high biocompatibility, and early replacement with bone. In this study, the response of bone-related cells to phosphorylated pullulan was evaluated to develop a new surface treatment method. Saos-2 (human osteosarcoma-derived osteoblast-like cells), MC3T3-E1 (mouse calvaria-derived osteoblast-like cells), and RAW264.7 (mouse macrophage-like cells) were used. In evaluating cellular responses, phosphorylated pullulan was added to the culture medium, and cell proliferation and calcification induction tests were performed. The proliferation and calcification of cells on the surface of Ti disks coated with phosphorylated pullulan were also evaluated. In addition, bone morphogenetic protein-2 (BMP-2), an osteogenic factor, was used to evaluate the role of phosphorylated pullulan as a drug carrier in inducing calcification on Ti disks. Phosphorylated pullulan tended to promote the proliferation of osteoblast-like cells and the formation of calcification on Ti disks coated with phosphorylated pullulan. Ti disks coated with phosphorylated pullulan loaded with BMP-2 enhanced calcification. Phosphorylated pullulan inhibited osteoclast-like cell formation. These results are due to the properties of phosphorylated pullulan, such as adhesiveness to titanium and drug-loading function. Therefore, phosphorylated pullulan effectively promotes bone regeneration when coated on titanium implants and is useful for developing a new surface treatment method.

Surface modification of biomedical titanium alloy for hard tissue repair and reconstruction

In biomedical applications, various materials are used, including metals and their alloys, polymers and ceramics. Among them, titanium (Ti) and titanium alloys are widely utilised in implant materials due to their excellent corrosion resistance and high mechanical strength. However, despite these advantages, titanium is biologically inert and does not integrate well with human cells. Therefore, surface modification of titanium implants plays a crucial role in determining the rate of osseointegration and the overall success of the implants. The primary objective of this review is to provide a detailed introduction to surface modification technologies for titanium alloy implants. The aim is to enhance the biological activity, wear resistance, corrosion resistance and antibacterial properties and reduce the release of ions from the implants. By modifying the surface of titanium implants, it is possible to create a more favourable environment for cell adhesion, proliferation and differentiation. Various techniques, such as physical methods (e.g. sandblasting, acid etching) and chemical methods (e.g. surface oxidation, plasma treatment) can be employed to modify the surface properties of titanium implants. These surface modification techniques can enhance the interaction between the implant and the surrounding biological environment, promoting osseointegration and improving the long-term stability of the implant. Additionally, surface modifications can help reduce the release of potentially harmful ions from the implant, minimise bacterial adhesion and improve the overall biocompatibility of the implant. In conclusion, surface modification of titanium alloy implants is a critical aspect of biomedical engineering. By improving the biocompatibility of titanium implants, these modifications contribute to the success and longevity of implants used in hard tissue repair and reconstruction.

Retraction Note: Biomechanical and histological evaluation of four different titanium implant surface modifications: an experimental study in the rabbit tibia.

Retraction Note: Biomechanical and histological evaluation of four different titanium implant surface modifications: an experimental study in the rabbit tibia.

Implant surface modifications and their impact on osseointegration and peri-implant diseases through epigenetic changes: A scoping review.

Dental implant surfaces and their unique properties can interact with the surrounding oral tissues through epigenetic cues. The present scoping review provides current perspectives on surface modifications of dental implants, their impact on the osseointegration process, and the interaction between implant surface properties and epigenetics, also in peri-implant diseases. Findings of this review demonstrate the impact of innovative surface treatments on the epigenetic mechanisms of cells, showing promising results in the early stages of osseointegration. Dental implant surfaces with properties of hydrophilicity, nanotexturization, multifunctional coatings, and incorporated drug-release systems have demonstrated favorable outcomes for early bone adhesion, increased antibacterial features, and improved osseointegration. The interaction between modified surface morphologies, different chemical surface energies, and/or release of molecules within the oral tissues has been shown to influence epigenetic mechanisms of the surrounding tissues caused by a physical-chemical interaction. Epigenetic changes around dental implants in the state of health and disease are different. In conclusion, emerging approaches in surface modifications for dental implants functionalized with epigenetics have great potential with a significant impact on modulating bone healing during osseointegration.

Bifunctional Piezo‐Enhanced PLLA/ZA Coating Prevents Aseptic Loosening of Bone Implants

AbstractPrevention of aseptic loosening, the main reason for secondary surgery of bone implants, is of great crucial clinical importance. As a promising bioactive material to promote bone regeneration, the piezoelectric materials for preventing aseptic loosening has not been reported. Here, a surface coating is presented for implants based on piezoelectric poly(L‐lactic acid) (PLLA). The coating ingeniously utilizes zoledronic acid (ZA), a drug used to treat osteoporosis, as a nucleating agent to enhance the piezoelectricity of PLLA. The coating can not only provide a continuous porous piezoelectric environment to stimulate osteogenic differentiation without intervention, but also effectively inhibit the osteolytic activity of osteoclasts through the slow release of ZA, achieving long‐term effectiveness with a single implantation. The rat femur cavity implantation experiment suggests that, the PLLA/ZA coating can rapidly initiate osseointegration of the implant and effectively mitigate the risk of aseptic loosening, even in the presence of metal submicroscopic particles that induce aseptic loosening. This strategy of piezo‐enhanced PLLA drug‐loaded coating may provide a new idea for the surface modification of bone implants.

Micro/nano-surface modification of titanium implant enhancing wear resistance and biocompatibility

Micro/nano structured surface has been shown to effectively enhance the biological performance of titanium alloy implants, exhibiting faster postoperative recovery. However, a common drawback of bio-functionalized surfaces featuring structured characteristics is their susceptibility to wear. This study proposed a novel micro/nano surface modification method using ultrasonic milling and anodization to enhance both biocompatibility and wear resistance of the implant surface. First, hierarchical structures are fabricated on the titanium surface by utilizing ultrasonic milling and anodization to generate micro-scale and nano-scale structures, respectively. Linear reciprocating tests, contact angle tests, and surface morphology observation were conducted to investigate the surface properties. Then, cell proliferative and adhesive abilities were tested on different modified surfaces by using mouse osteoblasts. Finally, nonosilver coatings were created on the structured surface by vapor deposition and the antibacterial performance was tested using staphylococcus aureus. The experiment results reveal a significant improvement in wear resistance, biological properties, and antibacterial capabilities of the processed surface, demonstrating the great application potential of the proposed method for implant surface modification.

Enhancement of bone mineral formation on Ti6Al4V surface by PM-EDCLT combined with acid etching

For Bone-anchored limb prostheses, osseointegration plays a significant role in the mechanically stable interface between bone and implants. Titanium alloy is the most usable alloy for hard tissue replacement. The drawbacks of the titanium implant are corrosion, leaching and poor osseointegration. In this research, powder mixed (hydroxyapatite) - electric discharge-assisted centreless turning (PM-EDCLT) (Impulse current- 5amp, duty factor- 57%, hydroxyapatite concentration 18 g/l, and rpm-360) and acid etching (solution – HF: HNO3: H2O = 1:2:50) were used for the surface modification of screw-fit implants. Average surface roughness value maximum in PM-EDCLT machined surface (1.249 µm) followed by PM-EDCLT machined + 5 min. Acid etching (1.055 µm), PM-EDCLT machined + 10 min. Acid etching (0.9829 µm), PM-EDCLT machined + 15 min. acid etching (0.8223 µm), bare surface with 10 min. Acid etching (0.2866 µm), 15 min. acid etching (0.2714 µm) and 5 min. Acid etching (0.1896 µm). Investigations using Scanning Electron Microscopy (SEM), Energy-Dispersive X-ray spectroscopy (EDS), X-ray diffraction (XRD), and Fourier Transform Infrared Spectroscopy (FTIR) proved that the deposited layer on the powder-mixed EDCLT machined sample was hydroxyapatite. After sinking samples in the Simulated Body Fluid (SBF) solution, it was concluded that the percentage of bone minerals like oxide, Ca, and P deposition increases after increasing the acid etching time on the PM-EDCLT machined surfaces. Little effect was found on the deposition of bone minerals on the surface of acid etching only by increasing the etching time. There is a clear trend of decreasing the contact angle with increasing the acid etching time on the PM-EDCLT surfaces.

Feasibility Insights of the Green-Assisted Calcium-Phosphate Coating on Biodegradable Zinc Alloys for Biomedical Application: In Vitro and In Vivo Studies.

In the field of bone tissue engineering, recently developed Zn alloy scaffolds are considered potential candidates for biodegradable implants for bone regeneration and defect reconstruction. However, the clinical success of these alloys is limited due to their insufficient surface bioactivities. Further, the higher concentration of Zn2+ produced during degradation promotes antibacterial activity, but deteriorates osteogenic properties. This study fabricated an Azadirachta indica (neem)-assisted brushite-hydroxyapatite (HAp) coating on the recently developed Zn-2Cu-0.5Mg alloy to tackle the above dilemma. The microstructure, degradation behavior, antibacterial activity, and hemocompatibility, along with in vitro and in vivo cytocompatibility of the coated alloys, are systematically investigated. Microstructural analysis reveals flower-like morphology with uniformly grown flakes for neem-assisted deposition. The neem-assisted deposition significantly improves the adhesion strength from 12.7 to 18.8 MPa, enhancing the mechanical integrity. The potentiodynamic polarization study shows that the neem-assisted deposition decreases the degradation rate, with the lowest degradation rate of 0.027 mm/yr for the ZHN2 sample. In addition, the biomineralization process shows the apatite formation on the deposited coating after 21 days of immersion. In vitro cytotoxicity assay exhibits the maximum cell viability of 117% for neem-assisted coated alloy in 30% extract after 5d and the improved cytocompatibility which is due to the controlled release of Zn2+ ions. Meanwhile, neem-assisted coated alloy increases the ZOI by 32 and 24% for Gram-positive and Gram-negative bacteria, respectively. Acceptable hemolysis (<5%) and anticoagulation parameters demonstrate a promising hemocompatibility of the coated alloy. In vivo implantation illustrates a slight inflammatory response and vascularization after 2 weeks of subcutaneous implantation, and neo-bone formation in the defect areas of the rat femur. Micro-CT and histology studies demonstrate better osseointegration with satisfactory biosafety response for the neem-assisted coated alloy as compared to that without neem-assisted deposition. Hence, this neem-assisted brushite-Hap coating strategy elucidates a new perspective on the surface modification of biodegradable implants for the treatment of bone defects.

In-situ construction of bioactive nanostructures on Ti alloy surfaces through ultra-low concentration alkali treatment and low-temperature annealing

Osseointegration is crucial for the long-term stability of orthopedic implants. Nanosurfacing can impart osteoinductivity to the implant. However, the application potential of most available nanotechnologies in surface modification of implants is limited, and there is an urgent need to develop new effective nanosurfacing techniques with greater practicality. In this study, we for the first time, utilized an ultra-low concentration NaOH solution (0.55 mM) combined with low-temperature annealing to achieve solid-state dewetting (SSD) on Ti alloy surfaces, resulting in well-defined TiO2 nanoisland-like crystals. In vitro cell experiments demonstrated that the constructed nanostructures significantly affected the adhesion, proliferation, and osteogenic differentiation capability of MC3T3-E1 cells. The nanostructures formed at 550 °C exhibited the most pronounced enhancement of cell osteogenic differentiation capability. This method is simple, easy to operate, and scalable, holding significant application potential in the surface modification of Ti alloys.

Evaluation of 3D Printing Orientation on Volume Parameters and Mechanical Properties of As-Build TI64ELI

The discovery of the utility of various titanium alloys as implant biomaterials has resulted in these materials becoming far more popular than other metals in the medical world. However, the production of these materials using additive manufacturing has its own challenges some of those being the surface finish that can be used as an implantology material. As such, the purpose of this study is to evaluate the influence of 3D-printed Ti64ELI on the as-built samples printed at 60°, 90°, and 180° orientations. Such studies are very limited, specifically in the development of the laser shock peening surface modification of dental implants. The study showed that each mechanical test that was performed contributes differently to the printing orientation, e.g., some tests yielded better properties when 180° printing orientation was used, and others had poorer properties when a 180° printing orientation was used. It was observed that 60° testing yielded a micro-hardness value of 349.6, and this value was increased by 0.37% when 90° orientation was measured. The lowest HV value was observed under a 180° orientation with 342.2 HV. The core material volume (Vmc) was 0.05266 mm3/mm2 at a 60° orientation, which increased by 11.48% for the 90° orientation. Furthermore, it was observed that the surface roughness (Sa) at 60° orientation was 43.68 μm. This was further increased by 6% when using the 90° orientation.

Surface modification of a commercial bone plate (Ti6Al4V) implant for improved antibacterial and cytocompatibility via thermal dewetting of a silver thin film

The high demand for bone grafts has motivated the development of implants with excellent osteogenic activity, whereas the risk of implant-associated infection, particularly given the rise of antimicrobial resistance, has compelled the development of implants with innovative antimicrobial strategies in which a small amount of bactericidal agent can effectively kill a wide range of bacteria. To induce antibacterial property, the surface of Grade-5 bone plate titanium implants used in clinical applications was modified using direct current (DC) sputter coating followed by thermal annealing. The 15 nm silver film-coated implants were thermally annealed in the furnace for 15 min at 750 °C. The modified implant surface’s antibacterial efficacy against Escherichia coli (E. coli), Staphylococcus aureus (S. aureus), Salmonella typhi, and Methicillin-resistant staphylococcus aureus bacteria has been assessed using a colony-forming assay. On the modified implant surface, the growth of E. coli and S. aureus bacteria is reduced by 99.72%, while highly drug-resistant bacteria are inhibited by 96.59%. The MTT assay was used to assess the cytotoxicity of the modified bone-implant surface against NIH3T3 mouse fibroblast cells. The modified bone-implant surface promoted fibroblast growth and demonstrated good cytocompatibility. Furthermore, the mechanical properties of the implant were not harmed by this novel surface modification method. This method is simple and provides new insight into surface modification of commercial metallic implants to have effective antibacterial properties against various classes of bacteria.

Application of metal–organic frameworks in stomatology

Metal–organic frameworks (MOFs), a new class of porous organic–organic hybrid materials controlled by self-assembly of metal atoms and organic pillars, are attracting considerable interest because of their specific properties. More recently, the advantages of different types of nanoscale metal–organic frameworks for the use of MOF nanoparticles in stomatology have been reported in the literature. This article covers the treatment of oral cancer, surface modification of implants, antibacterial dressings, and treatment of periodontitis and periodontal regeneration. It presents recent applications, future challenges, and prospects for MOFs in stomatology in four areas. It provides an overview of recent advances in the design and application of MOFs in stomatology from their intrinsic properties to different syntheses and their use as smart drug delivery systems or a combination of these.

Radiographic and histologic assessment of osseointegration for surface-treated titanium dental implants: An experimental study in dogs.

Modifying the dental implant's surface texture enhances its biological response to the bone and implant‒tissue interface, resulting in the successful support of forces. This study assessed the impact of sandblasting, sandblasting plus acid etching, Er,Cr:YSGG laser, and propolis implant surface treatments and occlusal load on the osseointegration of titanium dental implants in dogs. Seventy-two titanium dental implants with a diameter of 4 mm and a length of 10 mm were divided into four groups according to implant surface modifications (n=18 for each group): group A: sandblasting plus acid etching, group B: sandblasting with Al2 O3, group C: Er,Cr:YSGG laser, group D: propolis coating. Twenty-four local breed male dogs were used. Premolar teeth (P1, P2, and P3) were extracted on the left side of the mandible, and after 12 weeks of bone healing, implants were unilaterally installed. The osseointegration at three study times from implant installation (14, 90, and 180 days) was evaluated. The dog jaws were scanned using an intraoral scanner for the virtual design of screw-retained three-unit crowns after 90 days of osseointegration. Final radiographs were taken before the animals were sacrificed at 14, 90, and 180 days, and the histological analysis was performed. Radiographic analysis showed new bone formation (NBF) along and in contact with the implant surface of the treated groups. The histological analysis after 14 days in groups A and B revealed a uniform and ongoing pattern of bone growth and many osteoblasts with few osteocytes within lacunae in new bone trabeculae. Group C showed an increase in the number of osteoblasts lining thin bone trabeculae. Group D showed a generative power concerning bone. At 90 days, there was increased bone ingrowth, and the new bone matured in all the treated implant groups. At 180 days, dense mature bone apposition was in direct contact with delayed-loaded implant surfaces. A radiographic examination revealed that surface modification significantly impacted osseointegration, with a strong bond between the implant surface and the surrounding bone. The histological sections at the 14-day interval revealed obvious bone remodeling activity, especially in sandblasting plus acid etching and sandblasting-modified implant surface groups. At the 90-day interval, bone ingrowth had increased, and the new bone became mature, especially in sandblasting and propolis surface modification groups. After 180 days of the delayed-loaded implant osseointegration, differences were observed between different implant-treated groups with a remarkable remodeling of the bone, especially in the propolis coating group.

Plasma bias homopolar sputtering technology and its application to enhance bioactivity of polyetheretherketone surface

Numerous strategies have been developed to deposit metal-based films on biomedical implants to improve their performances. As a promising strategy, vacuum plasma plating technology can introduce many bioactive metals on the implant surface and achieve strong interfacial bonding. However, there are still limitations in the surface modification of a non-conductive matrix. Here, a simple and universal plasma-based technique termed plasma bias homopolar sputtering (PBHS) was presented to modify the insulating and conductive materials. The technical principles and characteristics of PBHS were comprehensively studied. As a demonstration, the Fe-based film was prepared on the surface of an insulating polyetheretherketone (PEEK) by PBHS to improve its biological performance. The as-prepared Fe-based film exhibited low elasticity modulus and good hydrophilicity, enhancing the adhesion, proliferation, and osteogenic differentiation of rat bone marrow mesenchymal stem cells. This work provides a simple and universal technique for the preparation of metal-based films, holding great potential for the surface modification of biomedical implants.

Current Progress and Future Perspectives in Contact and Releasing-Type Antimicrobial Coatings of Orthopaedic Implants: A Systematic Review Analysis Emanated from In Vitro and In Vivo Models.

Background: Despite the expanding use of orthopedic devices and the application of strict pre- and postoperative protocols, the elimination of postoperative implant-related infections remains a challenge. Objectives: To identify and assess the in vitro and in vivo properties of antimicrobial-, silver- and iodine-based implants, as well as to present novel approaches to surface modifications of orthopedic implants. Methods: A systematic computer-based review on the development of these implants, on PubMed and Web of Science databases, was carried out according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Results: Overall, 31 in vitro and 40 in vivo entries were evaluated. Regarding the in vitro studies, antimicrobial-based coatings were assessed in 12 entries, silver-based coatings in 10, iodine-based in 1, and novel-applied coating technologies in 8 entries. Regarding the in vivo studies, antimicrobial coatings were evaluated in 23 entries, silver-coated implants in 12, and iodine-coated in 1 entry, respectively. The application of novel coatings was studied in the rest of the cases (4). Antimicrobial efficacy was examined using different bacterial strains, and osseointegration ability and biocompatibility were examined in eukaryotic cells and different animal models, including rats, rabbits, and sheep. Conclusions: Assessment of both in vivo and in vitro studies revealed a wide antimicrobial spectrum of the coated implants, related to reduced bacterial growth, inhibition of biofilm formation, and unaffected or enhanced osseointegration, emphasizing the importance of the application of surface modification techniques as an alternative for the treatment of orthopedic implant infections in the clinical settings.