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Osseointegration is the privileged outcome of bone tissue healing around titanium implants. It is a biological process in which a direct anchorage is established by the formation of bone tissue around the implant without the growth of fibrous tissue at the bone-implant interface. Multiple phases of healing which are governed by a series of cellular and molecular events. Histologically, it has been shown that the process of bone formation at titanium implants is preceded by recruitment of cells of different types and at different levels of morphological differentiation. Bone would respond differently by altering the implant surface properties. Clinical success rates of implants with significant hydrophilicity, incorporation of innovative technologies through functionalization with biochemical nanocoating to locally release chemical compounds, mineral ions, and drugs, offer a potential to further develop enhance surface bioactivity and accelerate osseointegration. Adequate patient selection and treatment planning are essential to guarantee high predictability and long-term maintenance of the peri-implant marginal bone.
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