Implants interact with their environment through mesenchymal cells, which differentiate to osteoblasts. The interaction of cells with the implant is mediated by specific integrin receptors and includes their interrelationship with the microtopographical features of their substrate. Studies using mesenchymal and osteoblast-like cells indicate that proliferation, differentiation, and local factor production, as well as the response to local and systemic hormones, and mechanical and biophysical regulatory factors, are sensitive to substrate microstructural features. The nature of the response varies with the cell model examined and the stage of cell maturation. While it is evident that substrate microarchitecture affects many cell types in culture, the clinical significance of these in vitro observations to the success of dental implants is less clear. This chapter provides an overview of in vitro work and places it in the context of studies designed to test the importance of specific surface microtopographies clinically.
