This review concerns the importance of length and time on physicochemical interactions between living tissue and biomaterials that occur on implantation. The review provides information on material host interactions, materials for medical applications and cell surface interactions, and then details the extent of knowledge concerning the role(s) that surface chemistry and topography play during the first stage of implant integration, namely protein adsorption. The key points are illustrated by data from model in vitro studies. Host implant interactions begin nanoseconds after first contact and from then on are in a state of flux due to protein adsorption, cell adhesion and physical and chemical alteration of the implanted material. The many questions concerning the conformational form and control of bound proteins and how this may impact on cell adhesion in the first instance and later on cell signalling and implant integration can be answered by systematic investigations using model materials. Only then we will be in a more informed position to design new materials for use in the body.
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