Next-generation nanotechnology strategies for infection-resistant and bio-integrative implants

Biofilm-associated infections (BAIs) are a leading cause of implant failure due to their resistance to antibiotics and evasion of immune responses. Traditional treatments often require surgical removal - an invasive and costly intervention. This review critically evaluates recent advances (2024–2025), representing approximately 60 % of cited references, which focus on nanotechnology-driven strategies that prevent bacterial adhesion while enhancing bio-integration. A systematic literature search was conducted in PubMed, Scopus, and Web of Science using keywords such as biofilms , nanotechnology , implantable medical devices , nanoparticles , and infection prevention . The review adheres to the SANRA (Scale for the Assessment of Narrative Review Articles) framework to ensure methodological rigor. Newly emerging materials, including metal–organic frameworks (MOFs) and zwitterionic non-fouling polymers, exhibit synergistic antimicrobial and antifouling performance, while biosensor-integrated and wearable smart implants enable real-time infection monitoring. Comparative evaluation using the Technology Readiness Level (TRL) framework highlights translational progress, from preclinical prototypes to early clinical trials of silver- and copper-based implant systems. Despite remarkable progress, several translational challenges continue to limit large-scale clinical adoption. Key issues include nanoparticle cytotoxicity, long-term biocompatibility, standardized regulatory validation, and scalable manufacturing processes. Current applications extend across orthopedic, cardiovascular, dental, and auditory implants, while emerging directions such as artificial intelligence (AI)-guided design and biosensor integration are accelerating innovation toward safer, more adaptive, and clinically viable nanotechnology-enabled implants.