Surface treatment of titanium alloys and its influence on bacterial adhesion associated with peri-implantitis: a literature review

Tratamento de superfície de ligas de titânio e sua influência na adesão bacteriana associada à peri-implantite: uma revisão da literatura

ABSTRACT

This study systematically reviews surface treatment techniques for titanium alloys and their advantages in resistance to bacteria associated with peri-implantitis, in addition to investigating how these techniques influence the adaptation of titanium alloys in the oral environment. The research included articles published between 1996 and 2023 in databases such as Pubmed, SciELO, Google Scholar and ResearchGate. The methodology focused on the effects of photodynamic therapy and electrochemical anodization on titanium alloys, excluding studies of other interventions or materials. The results showed that the oxidation process is crucial in both treatment methods, forming an oxygen layer that prevents biofilm formation. Photodynamic therapy was effective in bacterial decontamination when used with a photosensitizer, while electrolytic plasma anodization showed promise in forming an oxide layer, essential for biocompatibility and corrosion resistance. The Ti6Al4V alloy is the most used in dentistry due to its mechanical properties, despite its high modulus of elasticity compared to human bone. Peri-implantitis is an inflammatory condition that compromises osseointegration, with photodynamic therapy and electrochemical anodization being effective methods of surface treatment to prevent this pathology. Studies have shown that photodynamic therapy is more efficient when combined with a photosensitizer, while electrochemical anodization, by forming an oxide layer, facilitates cell adhesion and prevents bacterial proliferation. It is concluded that both techniques are effective in the surface treatment of titanium alloys, with photodynamic therapy being more effective when combined with a photosensitizer and electrochemical anodization being beneficial due to the formation of the oxide layer. The choice of method depends on the type of bacteria and the specific treatment conditions.

Indexing terms
Bacterial adhesion; Peri-implantitis; Titanium

RESUMO

Este estudo revisa sistematicamente as técnicas de tratamento de superfície para ligas de titânio e suas vantagens na resistência a bactérias associadas à peri-implantite, além de investigar como essas técnicas influenciam a adaptação das ligas de titânio ao ambiente oral. A pesquisa incluiu artigos publicados entre 1996 e 2023 em bases de dados como PubMed, SciELO, Google Scholar e ResearchGate. A metodologia concentrou-se nos efeitos da terapia fotodinâmica e da anodização eletroquímica sobre ligas de titânio, excluindo estudos que abordassem outras intervenções ou materiais. Os resultados demonstraram que o processo de oxidação é fundamental em ambos os métodos de tratamento, promovendo a formação de uma camada de óxido que impede a formação de biofilme. A terapia fotodinâmica mostrou-se eficaz na descontaminação bacteriana quando associada a um fotossensibilizador, enquanto a anodização eletroquímica por plasma apresentou potencial na formação de uma camada de óxido, essencial para a biocompatibilidade e a resistência à corrosão. A liga Ti 6 Al 4 V é a mais utilizada na odontologia devido às suas propriedades mecânicas, apesar de apresentar elevado módulo de elasticidade em comparação ao osso humano. A peri-implantite é uma condição inflamatória que compromete a osseointegração, sendo a terapia fotodinâmica e a anodização eletroquímica, métodos eficazes de tratamento de superfície para a prevenção dessa patologia. Estudos indicam que a terapia fotodinâmica é mais eficiente quando combinada a um fotossensibilizador, enquanto a anodização eletroquímica, por promover a formação de uma camada de óxido, facilita a adesão celular e inibe a proliferação bacteriana. Conclui-se que ambas as técnicas são eficazes no tratamento de superfície de ligas de titânio, sendo a terapia fotodinâmica mais efetiva quando associada a um fotossensibilizador e a anodização eletroquímica vantajosa devido à formação da camada de óxido. A escolha do método depende do tipo de bactéria envolvida e das condições específicas do tratament.

Termos de indexação
Adesão bacteriana; Peri-implantite; Titânio

INTRODUCTION

Since the introduction of modern implant dentistry by Brånemark in 1960, titanium-based materials have been widely used due to their biocompatibility, low density, and high corrosion resistance [¹,²]. Currently, commercially pure titanium (TiCp) and the Ti6Al4V alloy stand out as the main materials used in implant dentistry, although their chemical, mechanical, and physical properties must be carefully considered to ensure long-term clinical success [³].

The composition of titanium alloys can include α and β crystalline phases, which determine their mechanical properties and their ability to adapt to the biological environment [⁴,⁵], β-type alloys are preferred for dental implants due to their reduced elastic modulus and high mechanical strength [⁶]. Studies have shown that the addition of elements such as niobium and tantalum can significantly reduce the elastic modulus, bringing it closer to that of human bone. Conversely, the introduction of zirconium can increase tensile strength and suppress martensite formation, thereby enhancing implant durability [⁶,⁷].

For implant manufacturing, characteristics such as biocompatibility, adequate mechanical strength, and an elastic modulus close to that of human bone are essential. The development of surface modification techniques aims to improve the interaction between the implant and biological tissues, reducing bacterial colonization and increasing the success rate of osseointegration. Techniques such as electrochemical anodization and Photodynamic Therapy (PDT) have been widely investigated due to their positive effects on biocompatibility and corrosion resistance [⁸-¹⁰].

Successful osseointegration is a critical process for the success of dental implants and depends on the interaction between fibroblasts and osteoblasts [¹¹]. Smooth surfaces favor fibroblast growth, whereas more irregular surfaces promote osteoblastic cell attachment and proliferation, resulting in improved bone integration51. The formation of a titanium oxide (TiO2) passivation layer is fundamental in this process, as it increases the material’s bioactivity and prevents bacterial adhesion [¹²,¹³].

However, despite its advantages, the Ti6Al4V alloy has an elastic modulus significantly higher than that of human bone, which may lead to bone resorption and compromise implant longevity [⁶]. Additionally, there are concerns regarding the release of toxic ions, such as vanadium (V), which can cause adverse effects in the human body [¹⁴].

Peri-implantitis is an inflammatory complication affecting the tissues surrounding a dental implant, leading to bone loss and, eventually, implant failure [¹⁵,¹⁶]. The etiology of peri-implantitis is strongly associated with the formation of bacterial biofilm on the implant surface, with microbial adhesion being a critical factor in disease development [¹⁷,¹⁸]. The literature emphasizes the importance of strategies to prevent bacterial colonization through implant surface modifications [¹⁹].

Several techniques have been proposed to modify implant surfaces, making them more bioactive and resistant to bacterial colonization. Among these, electrochemical anodization promotes the formation of an oxide layer with high crystallinity and corrosion resistance, while photodynamic therapy uses light and a photosensitizing agent to eliminate microorganisms [⁷,²⁰,²¹]. Both approaches have shown promising results, with evidence of increased resistance to bacterial adhesion and enhanced bone integration under various clinical and laboratory conditions.

The relevance of this review lies in the need to understand and compare the main surface modification techniques for titanium alloys, evaluating their effectiveness in preventing bacterial adhesion and promoting osseointegration. Continuous advancement of these techniques is crucial to minimize implant failures and improve patients’ quality of life. Understanding the underlying mechanisms of these modifications is fundamental for the development of new materials and technologies that can enhance implant durability and long-term success, consolidating more effective therapeutic approaches for the prevention and treatment of peri-implantitis, one of the major challenges in modern implant dentistry.

This study aims to perform a literature review of surface treatment techniques for titanium alloys and to investigate their advantages in resisting bacterial colonization associated with peri-implantitis. Additionally, it seeks to examine how these techniques influence the adaptation of titanium alloys in the oral environment. The literature review will provide a comprehensive analysis of the various available surface treatment methods, highlighting their effectiveness in preventing bacterial colonization and promoting successful integration of titanium implants. The findings of this study are expected to contribute to a better understanding of the mechanisms involved in the interaction between treated titanium alloy surfaces and oral bacteria, as well as to the development of more effective strategies for the prevention and treatment of peri-implantitis.

METHODS

The present study is a literature review. The search terms used in the databases were: titanium alloys, surface treatment, peri-implantitis, bacteria, PDT, and electrochemical anodization. Scientific articles published in English and Portuguese over the past 22 years (1996–2025) were selected. The databases used in this study included PubMed, Scientific Electronic Library Online (SciELO), Google Scholar, and ResearchGate.

The selected studies were experimental and epidemiological, with a preference for bibliographic and literature reviews. For inclusion, studies were evaluated based on the statistical effect of PDT and electrochemical anodization as surface treatments on titanium alloys, particularly regarding their effects on metabolic parameters in adults (>18 years) of both sexes. In addition, theses, dissertations, and course conclusion papers with the same thematic focus were included.

Exclusion criteria comprised studies evaluating the effects of interventions other than PDT and electrochemical anodization, materials other than titanium, or studies published in languages other than English or Portuguese. Subsequently, a critical analysis was conducted to evaluate the results obtained in each selected study. This process allowed for a thorough assessment of the methodologies and conclusions employed, aiming to identify trends, research gaps, and potential biases that could influence the interpretation of results.

RESULTS

The systematic search of the PubMed, Google Scholar, SciELO, and ResearchGate databases identified 50 articles related to surface modification techniques of titanium alloys and their implications in peri-implantitis prevention. After applying the inclusion and exclusion criteria, 19 studies were selected for detailed analysis.

Among the identified articles, most addressed surface treatment of titanium alloys; however, many studies focused on surgical components such as femoral and knee prostheses and were excluded for not being directly related to dentistry. Among the dentistry-focused studies, the majority used experimental models with rats or small titanium discs. Exclusion criteria included studies evaluating interventions other than photodynamic therapy and electrochemical anodization, materials other than titanium, and publications in languages not specified in the methodology.

In PubMed, five articles addressing different aspects of titanium surface modification were selected. Afonso et al. [³] highlighted the importance of using β-type alloys, such as Ti35Nb7Zr5Ta, which have a reduced elastic modulus closer to human bone, providing improved biomechanical compatibility. Al Najam et al. [¹] emphasized positive clinical outcomes of implants in young patients, highlighting the relevance of surface characteristics in osseointegration and the prevention of inflammatory complications. Li et al. [¹⁴] investigated the incorporation of calcium, phosphorus, and silver ions into titanium surfaces, showing that this modification enhances bacterial resistance and biocompatibility. Hao et al. [¹²] explored the effects of elements such as zirconium and tin in titanium alloys, demonstrating that these additions reduce stiffness and favor interaction with biological tissues. Finally, Sul et al. [²¹] described the benefits of electrochemical anodization in forming an oxide layer that improves cell adhesion and creates a physical barrier against bacterial colonization.

Recent studies have proposed innovative approaches to titanium surface modification. Kang et al. [²²] developed a Ti40Nb3Cu alloy with superior antibacterial properties and enhanced mechanical strength, treated with microarc oxidation. This approach maintained antimicrobial activity, while the porous layer formed promoted osseointegration, suggesting a promising application for peri-implantitis prevention.

On ResearchGate, eight articles were selected focusing on experimental and clinical approaches. Karthega et al. [⁹] analyzed the influence of applied potential in electrochemical anodization, showing that specific adjustments increase oxide layer thickness and enhance corrosion resistance. Oliveira et al. [¹⁰] reported that incorporating calcium, phosphorus, and magnesium into anodic films improves apatite formation and osteoblastic response. Robinson et al. [²³] highlighted the efficacy of magnesium-modified surfaces in inhibiting bacteria such as Escherichia coli and Staphylococcus aureus. Usacheva et al. [²⁴] investigated the efficacy of photodynamic therapy, concluding that methylene blue as a photosensitizer significantly reduces bacterial load on titanium surfaces. Pinheiro et al. [²⁵] demonstrated that PDT reduces microbial burden in periodontal pockets, suggesting its application as a complementary method for peri-implant infection control. Puckett et al. [²⁰] analyzed the relationship between titanium nanotopography and bacterial adhesion, concluding that nanomodified surfaces significantly reduce biofilm formation. Gursoy et al. [²⁶] conducted a comprehensive review of PDT in dentistry, highlighting its efficacy in infection control and potential as an adjuvant in peri-implant treatments. Romanos et al. [²⁷] reviewed the application of PDT in implant dentistry, emphasizing its potential in reducing bacterial load and enhancing implant longevity.

Additionally, Iwabuchi et al. [²⁸] demonstrated that combining silver ions with violet LED irradiation (400nm) produced potent bactericidal effects, attributed to hydroxyl radical formation. Subsequent application of calcium phosphate (CaP) coating via electrical current promoted significant bone regeneration on titanium surfaces, demonstrating an effective strategy for surface decontamination and functional recovery.

In Google Scholar, four articles were incorporated into the review. Goulart et al. [²⁹] compared the efficacy of different photosensitizers in PDT, demonstrating that methylene blue is the most effective in eliminating Aggregatibacter actinomycetemcomitans, a bacterium strongly associated with peri-implantitis. Ribeiro et al. [³⁰] evaluated the cytotoxicity of materials used in implants, emphasizing the importance of surface modification to mitigate adverse effects on human cells. Peloi et al. [³¹] analyzed the influence of LED light on bacterial photoinactivation, confirming that the combination of light and methylene blue significantly reduces microbial viability on titanium surfaces. Lee et al. [³²] investigated the effects of calcium chelators on bacterial biofilms, showing that anthraquinone compounds reduce biofilm formation and hemolytic activity of Staphylococcus aureus.

In SciELO, two studies were selected. Afonso et al. [³] performed a detailed analysis using transmission electron microscopy, revealing the phase separation hardening mechanism in β-Ti35Nb7Zr5Ta alloys, reinforcing their biomechanical advantages for implant applications. Barrantes and Guinea [³³] investigated the capacity of Aloe vera gel to inhibit collagenases and metalloproteinases, suggesting its potential use to minimize tissue degradation around dental implants.

A detailed analysis of the studies highlighted the importance of the oxidation process in both surface treatment methods. The formation of a titanium oxide (TiO₂) layer plays a key role in preventing bacterial adhesion and biofilm formation. Factors such as treatment temperature, electrolyte composition, and anodization conditions directly influence process efficacy. The results indicate that PDT, particularly when combined with photosensitizers such as methylene blue, is effective in reducing bacterial load. Conversely, electrochemical anodization promotes the formation of a protective layer that enhances biocompatibility and inhibits microbial proliferation. Both techniques appear promising for minimizing peri-implantitis occurrence and improving the longevity of dental implants.

DISCUSSION

The increasing use of dental implants in oral rehabilitations has driven the development of new titanium alloys and surface modification techniques. Long-term implant success is directly related to osseointegration and resistance to bacterial colonization, factors influenced by material composition and surface topography factors influenced by material composition, surface topography, and implant–abutment connection geometry [¹,²,³⁴].

The Ti6Al4V alloy, although widely used in implant dentistry due to its superior mechanical properties, has limitations, such as a high elastic modulus compared to human bone. This mismatch can lead to stress shielding, favoring bone resorption and, consequently, implant failure over time [⁶,¹⁴]. Studies indicate that the addition of elements such as niobium and tantalum can significantly reduce the elastic modulus, bringing it closer to that of human bone and improving biomechanical compatibility.

Biofilm formation on the implant surface is a critical factor in the development of peri-implantitis, an inflammatory condition that may lead to implant loss [¹⁵,¹⁶]. Bacterial biofilm consists of microbial communities adhering to the implant surface and resisting host defense mechanisms and conventional antimicrobial treatments [¹⁷,¹⁸]. For this reason, the development of modified surfaces that prevent biofilm formation has been a major focus of research [¹⁹].

Electrochemical anodization is an effective technique for titanium surface modification, creating an oxide layer that enhances biocompatibility and corrosion resistance. Studies show that this oxide layer acts as a physical barrier against bacterial adhesion while promoting osseointegration by facilitating osteoblastic cell adhesion and proliferation [⁷,²⁰,²¹]. Moreover, the morphology of the layer formed by anodization can be adjusted by controlling parameters such as applied voltage and electrolyte composition, allowing optimization of implant properties.

Another promising approach is photodynamic therapy PDT, which combines the application of a photosensitizing agent with light irradiation at a specific wavelength to generate reactive oxygen species capable of destroying microorganisms [²⁷,²⁹]. PDT has been shown to be effective in bacterial decontamination of titanium surfaces, particularly when combined with photosensitizers such as methylene blue [²⁵]. In vitro studies have demonstrated a significant reduction in bacterial load on PDT-treated implants, suggesting its potential as a complementary method for peri-implantitis prevention and treatment [²⁷,³¹].

The combination of these techniques may provide synergistic benefits. While electrochemical anodization creates a physical barrier, and promotes osseointegration, PDT offers an active strategy for eliminating already-formed biofilms. However, the effectiveness of both approaches depends on factors such as material composition, photosensitizer concentration, and the conditions of the oral microenvironment [⁷,³²].

Furthermore, the choice of surface modification method should consider the specifics of each clinical case, such as the type of bacteria involved and the bone density at the implant site. Studies suggest that customizing anodization parameters and appropriately selecting the photosensitizer can maximize the beneficial effects of these techniques.

Technological advances have enabled novel synergistic approaches. For example, the use of violet LED combined with metallic ions has shown potential to eliminate resistant biofilms and promote bone regeneration, as demonstrated by Iwabuchi et al. [²⁸]. Similarly, microarc oxidation applied to alloys such as Ti40Nb3Cu, reported by Kang et al. [²²], simultaneously promotes antibacterial and bioactive properties.

Additionally, Öztürk et al. [³⁵] evaluated the effects of diode and Er: YAG lasers on SLA surfaces of grade 4 titanium and titanium-zirconium alloys. They concluded that the diode laser better preserves surface topography and is more suitable for peri-implantitis treatment than the Er: YAG laser, which causes localized erosion and fusion, compromising the implant structure.

In summary, the literature shows that electrochemical anodization and photodynamic therapy are effective for titanium surface modification, presenting distinct yet complementary benefits. The integration of these approaches into clinical protocols can improve implant longevity and reduce the incidence of complications such as peri-implantitis, representing a significant advancement for modern implant dentistry [¹⁰,³⁶].

CONCLUSION

1. Peri-implantitis represents one of the major challenges in contemporary implant dentistry, with implant surface modification being one of the most promising strategies for its prevention.

2. The techniques addressed in this review, electrochemical anodization and photodynamic therapy, proved effective in inhibiting bacterial colonization, provided that the type of microorganism, the patient’s clinical conditions, and, in the case of PDT, the use of photosensitizers at appropriate concentrations are carefully considered.

3. Photodynamic therapy demonstrated greater efficacy when combined with methylene blue, a widely used photosensitizer, whose action depends directly on the applied concentration and the microbiological profile present. Electrolytic plasma anodization, on the other hand, promotes the formation of an oxide layer on the titanium surface, acting as a physical barrier against bacterial adhesion and favoring osseointegration.

Therefore, both techniques offer positive and complementary outcomes, with the choice of method depending on the specific microbiological and clinical characteristics of each case. The integration of these approaches may represent a significant advancement in implant longevity and peri-implantitis control.

• Article aligned with the Good Health and well-being goal of the Sustainable Development Goals (SDGs).
• How to cite this article
  Galvani LD, Oliveira JJR, Silva LAP, Bordini EAF, Santiago Júnior JF, Vaz LG. Surface treatment of titanium alloys and its influence on bacterial adhesion associated with peri-implantitis: a literature review. RGO, Rev Gaúch Odontol. 2026;74:e20260027. http://dx.doi.org/10.1590/1981-86372026002720260009

Data Availability

No new data were created or analyzed in this study.

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Edited by

• Editor
  Ney Soares de Araújo

Publication Dates

• Publication in this collection
  17 Aug 2026
• Date of issue
  2026

History

• Received
  27 Jan 2026
• Accepted
  30 Apr 2026