Smart Dental Implants: From Scaffolds to Bio-Interfaces. A Comprehensive Review

Dental implants have undergone a revolutionary shift, no longer acting as mere mechanical anchors but as interactive bio-interfaces that communicate directly with the body. This review highlights the evolution of these "smart" implants, engineered with increasingly sophisticated surfaces that actively coach healing. We begin by exploring how physical and chemical modifications, such as complex micro-nano textures and super-hydrophilic treatments, to simultaneously promote bone integration and inhibit harmful bacteria.The review extended to molecular programming, where implant surfaces are coated with bioactive molecules like growth factors and antimicrobial compounds. These coatings provide precise stimulus to surrounding tissues, accelerating bone growth, and providing a powerful defense against infection. The most innovative developments lie in intelligent systems that can detect and respond to their environment. Surprisingly, these implants can release antibiotics only when an infection is detected or selectively guide the immune system to support healing rather than inflammation.Furthermore, we examine the frontier of epigenetic programming, where implants can influence gene expression to enhance regeneration in compromised patients. Despite the exciting potential of these technologies, this review also addresses the real-world challenges blocking their clinical adoption, including the need for more robust randomized clinical trials, and navigating complex regulatory standards. The future of implantology lies in creating truly adaptive, personalized solutions that can predict and respond to patient needs.