Strategies to Prevent Bacterial Infections on Titanium-Based Orthopedic and Dental Implants

Titanium and titanium alloys remain the gold standard for dental and orthopedic implants. These materials are heavily used because they are bioinert, have strong mechanical properties, and promote integration with bone. However, implant-associated infections (IAIs) remain one of the leading causes of implant failure. Eradicating an IAI can be difficult since bacteria can form biofilms on the medical implant, protecting the bacterial cells against systemic antibiotics and the host’s immune system. If the infection is not treated promptly and aggressively, device failure is inevitable, leading to costly multi-step revision surgeries. To circumvent this dire situation, scientists and engineers continue to fabricate novel strategies to protect the surface of medical implants from bacteria. In this review, we report on emerging strategies to prevent infection in titanium implants. These strategies include anti-adhesion properties provided by polymers, superhydrophobic, superhydrophilic, and liquid-infused surface coatings, as well as strategies and coatings employed to lyse the bacteria. We also explore commercially available technologies or under clinical trials and discuss future trends.