Approaches based on passive and active antibacterial coating on titanium to achieve antibacterial activity

Titanium (Ti) and its alloys are widely applied as orthopedic implants for hip and knee prosthesis, fixation, and dental implants. However, Ti and its alloys are bioinert and susceptible to bacteria and biofilm formation. Strategies for improving the antibacterial properties of Ti can be divided into two approaches, namely, passive coating and active coating on the Ti surface. Passive coating on Ti mainly kills the bacteria in contact but does not kill plankton or bacteria dwell in the bone tissue around the Ti implant. Active coating mainly involves the release of antibacterial agents to kill the bacteria, but this may result in the development of bacterial resistance. Both strategies include advantages and disadvantages. This article reviews the current and potential future approaches for improving antibacterial activity on Ti. We mainly focus on current approaches for fabricating antibacterial Ti and its limitations and countermeasures, and provide direction for further studies of biofunctionalization of Ti with antibacterial properties. © 2018 Wiley Periodicals, Inc. J Biomed Mater Res Part A: 106A:2531–2539, 2018.