Material surfaces can directly influence cell response, ultimately aff
ecting the rate and quality of new tissue formation. Initial events in
clude oriented adsorption of molecules from the surrounding fluid, cre
ating a conditioned interface to which the cell responds. Surface chem
istry and energy determine the type and orientation of adsorbed molecu
les, which then directs cellular attachment. Focal attachments between
the cells and substrate determine cell shape which, when transduced v
ia the cytoskeleton to the nucleus, may result in expression of specif
ic phenotypes. Osteoblasts and chondrocytes are sensitive to subtle di
fferences in surface roughness and surface chemistry. Cellular respons
e also depends on the local environment and state of maturation of res
ponding cells. Titanium (Ti) is one of the most commonly used material
s in bone. Morphologic and cell adhesion studies have provided informa
tion concerning the interface and initial interaction with Ti, while s
tudies investigating the biochemical response of cells to Ti have lagg
ed behind. The optimal surface characteristics necessary to predictabl
y elicit good bone formation are still under investigation. In this pa
per, we review how surface characteristics affect cellular response to
implant materials and discuss studies suggesting that cell maturation
state plays a role in cellular response to Ti.