Osseointegration Process Improving via Functionalization of Titanium Dioxide Nanotubes: A Bibliometric Analysis and Systematic Review

Failures of osseointegrated implants pose a significant challenge in the medical field, often attributed to prolonged osseointegration periods and bacterial infections. Functionalization of Titanium Dioxide Nanotubes (TNTs) has emerged as a promising strategy to improve osseointegration and mitigate infections. This study aims to conduct a bibliometric analysis and systematic review to identify trends, gaps, and advancements in research on the functionalization of TNTs for osseointegration improvement. Articles were retrieved from the Web of Science database using the keywords "osseointegration," "titanium dioxide nanotubes," and "functionalization." The inclusion criteria were studies published between 2014 and 2023, written in English, and focusing on the use of TNTs in implant surface modifications. A total of 126 articles were included after screening. Data extraction and analysis were performed using VOS Viewer, Microsoft Excel, and GraphPad Prism. The review revealed a growing number of publications on TNT functionalization, with China, the United States, and Brazil leading in contributions. Key findings include the effectiveness of TNTs loaded with bioactive agents (e.g., silver, strontium, hydroxyapatite) in promoting osseointegration and antibacterial activity. Collaborative networks among institutions and authors were mapped, highlighting the Sao Paulo State University and Yong Huang as the most prolific contributors. The findings underscore the potential of TNT functionalization to enhance implant performance. However, a gap remains in translating preclinical findings into clinical trials. Future research should focus on clinical validation to bridge this gap and translate laboratory advancements into therapeutic solutions.