The Role of Surface-Modified Titanium Scaffolds and Implants in Tissue Engineering for Bone Healing in Maxillofacial and Reconstructive Surgery

Abstract

Titanium and titanium alloys are widely used in maxillofacial and reconstructive surgery because they combine mechanical strength, corrosion resistance, manufacturability, and long-term biocompatibility. Their applications include dental implants, mandibular reconstruction plates, titanium mesh, patient-specific implants, orbital reconstruction systems, cranial implants, zygomatic implants, and additively manufactured porous scaffolds. Although titanium provides reliable mechanical stability, its biological performance depends strongly on the surface–tissue interface rather than on bulk material properties alone. Surface chemistry, oxide-layer characteristics, roughness, wettability, and micro/nanotopography influence protein adsorption, osteoblast adhesion, macrophage phenotype, angiogenesis, bacterial adhesion, and osseointegration. This narrative review critically synthesizes current knowledge on surface-modified titanium scaffolds and implants for bone healing in maxillofacial and reconstructive surgery, with emphasis on biological mechanisms, clinical relevance, translational limitations, and future directions. The available evidence supports the concept that optimized titanium surfaces can promote osteogenesis, vascularization, osteoimmunomodulation, and antibacterial activity, but clinical translation remains limited by heterogeneous surface characterization, simplified preclinical models, and insufficient long-term clinical data.