Titanium (Ti) implants that realize rapid osseointegration are required for favorable outcomes. Rough implant surfaces favor osseointegration, hence, coating implants with natural bone mineral, i.e., carbonate apatite (CO3Ap), may be effective for osseointegration. To achieve rapid osseointegration, rough-Ti substrates are coated with CO3Ap (CO3Ap-Ti) and the effects are evaluated in vitro and in vivo. For comparison, rough-Ti without coating (rough-Ti) and calcite-coated rough-Ti (calcite-Ti) substrates are fabricated. The adhesive strengths of calcite and CO3Ap to the substrates are ≈56.6 and ≈76.8 MPa, respectively, being significantly higher than the strength defined in ISO13779-2 (15 MPa). Calcite and CO3Ap coatings significantly promote preosteoblastic MC3T3-E1 cell proliferation. Additionally, the CO3Ap coating promotes higher osteogenic differentiation activity than the calcite coating. Implantation of CO3Ap-Ti into rabbit tibia defects prompts bone maturation, compared to calcite-Ti or rough-Ti implantation. The bone-implant contact percentage with CO3Ap-Ti and calcite-Ti is higher than that with rough-Ti. Consequently, CO3Ap-Ti acquires a robust bond with the host bone at an early stage (4 weeks postimplantation), compared to calcite-Ti or rough-Ti: the CO3Ap-Ti–bone bonding strength is ≈1.9- and ≈5.5-fold higher than that of calcite-Ti and rough-Ti, respectively. Thus, CO3Ap coating of Ti implants effectively achieve rapid osseointegration.
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