Osseointegration of metallic devices: Current trends based on implant hardware design

•Critical review of bone healing related to implant hardware.•Bone healing is remarkably affected by implant macrodesign and surgical drilling.•Multiple healing modes are described depending on hardware interplay with bone.

Osseointegration of metallic devices has been one of the most successful treatments in rehabilitative dentistry and medicine over the past five decades. While highly successful, the quest for designing surgical instrumentation and associated implantable devices that hastens osseointegration has been perpetual and has often been approached as single variable preclinical investigations. The present manuscript presents how the interplay between surgical instrumentation and device macrogeometry not only plays a key role on both early and delayed stages of osseointegration, but may also be key in how efficient smaller length scale designing (at the micrometer and nanometer scale levels) may be in hastening early stages of osseointegration.