Low-temperature plasma surface modification of titanium dental implants: mechanisms, biological effects and clinical perspectives

Titanium and its alloys have become the most widely used materials for dental implants in clinical practice, owing to their excellent mechanical properties and long-term biocompatibility. Nevertheless, insufficient early osseointegration and peri-implant infection remain major clinical challenges. Low-temperature plasma (LTP) has emerged as an effective surface modification strategy that enables non-thermal physicochemical modification of titanium surfaces without altering bulk material properties. Experimental studies demonstrate that LTP treatment induces pronounced changes in surface chemistry, including the introduction of reactive functional groups and increased surface wettability. These physicochemical modifications regulate protein adsorption at the implant interface, thereby influencing subsequent cellular and bacterial responses. Both in vitro and in vivo investigations confirm that plasma-treated titanium surfaces promote osteoblast adhesion, proliferation, and differentiation, modulate the peri-implant immune-inflammatory microenvironment, and simultaneously inhibit bacterial attachment and biofilm formation. This combination of pro-osteogenic and antibacterial effects is particularly advantageous for dental implant applications. In this review, we critically examine the mechanisms underlying plasma-surface interactions and their biological consequences, with an emphasis on osteogenic and antibacterial outcomes relevant to dental implants. Current challenges related to treatment durability, reproducibility, and clinical standardization are also discussed, with the aim of providing a theoretical basis and reference for the clinically standardized application of LTP-based surface modification.