Nano-Modified Titanium Implant Surfaces for the Prevention and Treatment of Peri-Implantitis: A Review

Abstract: Peri-implantitis is a primary cause of long-term implant failure, and its pathogenesis is closely associated with the formation of bacterial biofilms on implant surfaces. Conventional therapies, such as mechanical debridement and local/systemic antibiotic administration, have limitations in achieving sustained antibacterial effects. In recent years, nano-modification technologies for implant surfaces have demonstrated significant potential by endowing implants with active antibacterial and biological regulatory functions. This article is a review focusing on titanium and titanium alloy implants. It summarizes three major nano-modification strategies: nanotopography modulation, nanomaterial functionalization, and nano-drug delivery systems. The review focuses on the mechanisms of action by which these strategies synergistically inhibit biofilm formation and promote osseointegration through multiple pathways, including physical disruption, ion release, reactive oxygen species (ROS) generation, and intelligent responsive release. In addition, it summarizes the key design principles for implant surface nano-modification and discusses the challenges and future directions for clinical translation. It is important to note that most current evidence remains at the preclinical stage, underscoring the urgent need for more clinical trials to validate the long-term efficacy and safety of these approaches. This review aims to provide a theoretical framework for the development of next-generation smart implants that integrate anti-infective and osseointegration-promoting functions. Keywords: peri-implantitis, nanotopography, nanomaterial, nano-drug delivery system, antibacterial