A review of the advances in implant technology: accomplishments and challenges for the design of functionalized surface structures

Abstract Biomedical implants are extensively utilized to replace hard-tissue defects owing to their biocompatibility and remarkable tissue-affinity. The materials and functional design are selected based on the resultant osseointegration level and resistance to infection, and these considerations constitute the dominant research topic in this field. However, high rates of implantation failure and peri-implantitis have been reported. Current research on biomedical-implant design encompasses enhancement of the implant surface properties, such as the roughness, nano/micro topography, and hydrophilicity, along with the realization of advanced features including antibacterial properties and cell and immunomodulation regulation. This review considers the two achievements of contemporary implant manufacturing; namely, osseointegration and the realization of antibacterial properties. Present mainstream surface modifications and coatings are discussed, along with functional design technologies and achievements. The impacts of direct surface-treatment techniques and osteogenic functional coatings on osseointegration performance and antibacterial surface structures are elucidated, considering inorganic and organic coatings with antibacterial properties as well as antibiotic-releasing coatings. Furthermore, this review highlights recent advancements in physically driven antimicrobial strategies. Expanding upon existing research, future directions for implant studies are proposed, including the realization of comprehensive functionality that integrates osseointegration and antibacterial properties, as well as patient-specific design. Our study presents a comprehensive review and offers a novel perspective on the design of biomedical implants for enhanced versatility. An in-depth exploration of future research directions will also stimulate subsequent investigations.