ABSTRACT
Titanium implants have attracted a great deal of scientific interest since Bränemark explored its extraordinary biocompatibility with the human bone allowing the salvage of the limbs instead of amputation. In the last two decades the demand of patients for a higher quality of life has significantly increased, implying the need for shorter hospitalization time and complete recovery. As the response for this need a lot of research has taken place in the domain of the surface treatment of titanium implants with the aim to improve the mechanical characteristics of the implant surface, like surface roughness, hydrophilic/lipophilic character or the chemical composition. As a result of the intense research activity the titanium implants have become available for a much broader patient population than before, which improved the quality of life of a significant portion of patients. However, the dramatic expansion in the application of the titanium implants shed light on some unforeseen risk factors, such as immune-inflammatory response and implant-associated infections. In this chapter, we will introduce titanium’s chemical properties as an example of the complexity of the interface between cells and biomaterials and how subtle differences can have important consequences. Recent studies have shed some light on the effects of surface treatments on the immune response to titanium, which will be covered within the chapter. However, it is obvious that all risks pertaining to immune response to titanium cannot be mitigated at the current level of surface treatment technology. In contrast, the recent scientific achievements in the field of the photocatalysis have markedly increased our understanding in the electronic structure of titanium-dioxide, and so in its electrochemical and chemical properties. We presume that the utilization of those achievements in the surface treatment of titanium implants with a specific focus on surface crystalline phase may allow the production of devices with enhanced clinical performance from the point of view of immune reactions to titanium implants.
