Next Generation Smart Implant Surfaces: Engineering Multifunctional Antimicrobial, Immunomodulatory and Regenerative Interfaces

Dental implants rely on a stable and functional interface between the implant surface, surrounding tissues, and the oral microbial environment. While titanium remains the clinical gold standard due to its mechanical properties and capacity for osseointegration, peri-implant inflammation and biofilm-associated infection continue to compromise long-term outcomes. Consequently, there is growing interest in multifunctional implant surfaces capable of simultaneously regulating microbial colonisation, immune responses and peri-implant tissue integration. Advances in surface engineering and biomaterials science have revealed that implant surface chemistry and micro- and nanoscale topography strongly influence protein adsorption, immune activation, cellular behaviour, and bacterial attachment at the host-implant interface. Inspired by naturally antimicrobial and self-cleaning biological surfaces, biomimetic approaches have led to the development of mechano-bactericidal nanostructured titanium interfaces capable of physically inactivating bacteria while maintaining cytocompatibility and enhancing osteogenesis. This review examines the mechanobiological principles governing host-implant interactions and examines current strategies for engineering multifunctional antimicrobial, immunomodulatory, and regenerative implant surfaces. The translational challenges limiting clinical implementation, including mechanical durability, biological masking of engineered surfaces and long-term functional stability, are also discussed, together with emerging interest in alternative implant materials such as zirconia. Collectively, biomimetic multifunctional implant surfaces represent a promising strategy for improving long-term implant integration and peri-implant tissue health, although further translational and clinical validation remains necessary before widespread clinical adoption.