Titanium dental implants are currently one of the best treatment alternatives for replacing missing teeth. The direct bond that forms between the jawbone and titanium in a process defined as osseointegration has made titanium the material of choice for such devices. Whilst the underlying biological mechanisms responsible for the osseointegration process have not been fully elucidated, high demand by both patients and clinicians has driven the clinical application of titanium implants. Modification of the surface properties of titanium has been proven to be effective in promoting osseointegration, and thus understanding the fundamental cellular and molecular mechanisms responsible for the clinically observed outcomes as a result of titanium surface modification is the focus of considerable research. Previous research in this field has, as expected, focused on osteoblasts as they are the bone forming cells. This however, ignores the possible fundamental role of early mediators of the healing process, such as platelets and macrophages, which may interact with the implant surface well ahead of osteoblasts. As platelets and macrophages have well documented roles in modulating the function of other cells including osteoblasts, it is reasonable to postulate that the events that occur during the very early stages of the healing process may modulate repair in later stages, and ultimately influence the final osseointegration outcome.