Cell responses to titanium and titanium alloys

Commercially pure titanium and titanium alloys have been extensively used for designing musculoskeletal implants due to their biocompatibility and mechanical properties. The clinical success of these implants relies on supporting favorable osteoimmune environment, which then regulates bone regeneration and evades bacterial infection. Several surface engineering strategies have been employed to impart multifunctional properties to the otherwise bioinert titanium and titanium alloys. This chapter outlines these strategies, which encompass physical and chemical modification and their downstream effects on cell responses. In particular, we introduce the effect of these modifications on cells from hard and soft tissue along with their antibacterial properties and immune-modulatory effects. This chapter provides an up-to-date summary of where we are and how the understanding of the cellular response in vitro can help up drive the implant design for effective tissue repair and regeneration in clinical scenarios.