Society of Diabetic Nephropathy Prevention Journal of Preventive Epidemiology 2476-3934 11 2 2026 07 01 The role of surface-modified titanium in tissue engineering for maxillofacial and reconstructive surgery; a narrative review study e39357 e39357 10.34172/jpe.39357 EN Abbas Jasim Mohammed https://orcid.org/0009-0009-5430-7490 Shaikhaliev Astemir Ikramovich https://orcid.org/0000-0002-4920-7171 Qais Mussa https://orcid.org/0009-0009-6436-3189 Journal Article 10.34172/jpe.39357 2026 04 28 2026 06 22 Titanium and its alloys are widely used in maxillofacial and reconstructive surgery owing to their excellent biocompatibility, mechanical strength, and corrosion resistance. Despite these advantages, the inherent biological inertness of unmodified titanium limits its capacity for spontaneous osseointegration and increases susceptibility to peri-implant infections, thereby necessitating the development of surface modification strategies. This narrative review evaluates the necessity and clinical relevance of surface-modified titanium within the framework of tissue engineering, with a particular focus on applications in maxillofacial and reconstructive surgery. A targeted literature search was performed in the PubMed, Scopus, and Web of Science databases as well as the Google Scholar search engine using the keywords (titanium AND surface modification) combined with (maxillofacial OR craniofacial OR reconstructive surgery OR tissue engineering OR osseointegration OR bone healing). The search was restricted to peer-reviewed English-language articles, with emphasis on studies published between 2016 and 2026. Eligible studies included reviews, clinical investigations, and both in vitro and in vivo studies, while non-English publications and conference abstracts without full text were excluded. The findings demonstrate that surface modification significantly improves osseointegration, enhances bone regeneration, and imparts antimicrobial properties. Common approaches include sandblasting and acid-etching, anodization leading to nanotube formation, micro-arc oxidation (MAO), hydroxyapatite (HA) coatings, biomolecular functionalization using bone morphogenetic proteins such as bone morphogenetic proteins (BMP)-2 and BMP-7, and the application of three-dimensional printing to create porous architectures. These techniques operate across macro-, micro-, and nano-scale levels and target various stages of the bone–implant healing cascade. Overall, surface-modified titanium represents a clinically valuable and evidence-based strategy for improving outcomes in maxillofacial and reconstructive procedures. The incorporation of tissue engineering principles into implant surface design, particularly through the development of bioactive, antimicrobial, and structurally optimized surfaces, signifies a major advancement in craniofacial reconstruction. Further research focusing on multifunctional surface modifications and the translation of experimental findings into clinical practice remains essential.