Bridging the missing middle in osseointegration: meso-scale topography between macro design and microroughness
Abstract
Purpose: Despite decades of clinical success with microrough implant surfaces, persistent challenges-particularly the biological trade-off between osteoblast proliferation and differentiation-highlight the need for novel surface design strategies. This review investigates the potential of meso-scale topography (10-500 μm) as a promising and underexplored dimension in implant surface engineering, situated between macro-level implant geometry and conventional microroughness.
Methods: A systematic review, supplemented by a targeted literature search, was conducted to evaluate the biological and mechanical roles of meso-scale surface features on titanium, zirconia, and scaffold materials. Studies employing laser texturing, chemical etching, and 3D printing/additive manufacturing were critically assessed. Comparative insights across nano-, micro-, and meso-scale features were synthesized to delineate their distinct and synergistic contributions to osseointegration.
Results: Meso-scale features confer unique biological and mechanical advantages not achievable by nano- or micro-scale designs alone. These include enhanced osteoblast recruitment/attachment, spatial organization, extracellular matrix alignment, and mechanical interlocking. Notably, meso-topography appears to resolve the classic proliferation-differentiation dichotomy observed with microrough surfaces. Many meso-scale designs also exhibit increased interfacial surface area, correlating with superior mechanical…
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