Titanium continues to be one of the most widely utilized biomaterials for use in prosthetic devices to provide anchorage into bone. In particular, titanium implants have found widespread usage in dentistry for the purpose of anchoring dental prostheses providing a superior solution over conventional prostheses for the replacement of lost teeth. A major part of this success stems from its strength and favorable weight, but most importantly its outstanding biocompatibility. Research continues however on processes that can be applied to enhance and improve the clinical utility of titanium. Of the many strategies employed, surface modification to manipulate surface chemistry and topography has proven to be most effective. Recent evidence suggests that part of the success of these titanium surface modifications may be due to a subsequent modulation of the immune response to decrease inflammation and ensure a timely switch to a more reparative microenvironment. Micro-rough sandblasted and acid etched titanium has been widely used as a model of choice for assessing the effect of topographical surface modification on a variety of bone healing related biological mechanisms. Our group has used this surface and its modifications as a model to study the in vivo and in vitro effects of surface topographical modification on the cellular and molecular mechanisms associated with osseointegration, including the influence on inflammation.