Tailoring nanotopography and antibacterial properties of calcium phosphate bone grafts via fluoride incorporation

Despite advances in bone graft design and surgical techniques, bacterial infection remains a major cause of graft failure, exacerbated by the global rise in antimicrobial resistance. This has intensified the pursuit of antibiotic-free strategies to prevent bacterial colonization. Among these, antibacterial surface nanotopographies have emerged as promising tools, leveraging nanoscale geometries to physically disrupt bacteria upon contact. In this study, we engineered the surface of a calcium phosphate bone graft to confer antimicrobial functionality through a dual approach: the creation of high-aspect-ratio nanotopographies and ionic doping with fluoride. Through controlled hydrolysis of α-tricalcium phosphate by biomimetic and hydrothermal treatments, we generated calcium deficient hydroxyapatite nanoneedle structures whose morphology and biofunctionality were tuned via fluoride incorporation. XRD and Raman spectroscopy confirmed the formation of hydroxy-fluorapatite, with phase composition and surface morphology dependent on fluoride concentration and processing parameters. Fluoride doping significantly altered nanoneedle dimensions and spacing and enhanced bactericidal activity, particularly against <i>P. aeruginosa</i>, and to a lesser extent <i>S. aureus</i>. Notably, fluoride-doping alone showed no antibacterial effects; however, when combined with nanotopography, a synergistic increase in efficacy was observed. Importantly, the antimicrobial surfaces supported the proliferation and osteogenic differentiation of SaOS-2 cells. Co-culture assays modeling pre- and post-implantation infection scenarios demonstrated robust cell adhesion and markedly reduced bacterial colonization. In conclusion, our findings present a multifunctional, synthetic bone graft with both physical and chemical antibacterial properties, offering a promising strategy to mitigate infection risks while supporting osteointegration.