This review discusses the role of nanoscale topography in enhancing osseointegration of dental implants. The goal is to evaluate how nanoscale surface modifications of titanium substrates can improve bone integration. Nanotechnology offers new ways to interact with biological processes and has enabled understanding and achieving cell-specific functions. Various techniques can impart nanoscale topographic features to titanium endosseous implants. Existing data suggest that nanoscale modification can modulate critical steps in osseointegration. Important distinctions between nanoscale and micron-scale modifications are considered. The advantages and disadvantages of nanoscale modification are discussed. Available data on current dental implant surfaces using nanotopography in clinical dentistry are described. Nanoscale modification of titanium endosseous implant surfaces can alter cellular and tissue responses that may benefit osseointegration and dental implant therapy. The review highlights the significance of micron-scale topography in enhancing bone-to-implant contact. It discusses the biomechanical theory, contact osteogenesis, and surface signaling hypothesis. The role of surface roughness in osseointegration is explained, along with the effects of surface topography on cell behavior. The review also explores the application of nanotechnology to the dental implant surface, including nanoscale surface engineering and the use of nanoscale features to induce intrinsic osteoinductive signaling. The review discusses the effects of nanoscale topography on cell adhesion, proliferation, differentiation, and selectivity of adhesion. It also addresses the impact of nanoscale topography on the surface reactivity of the implant and the relative value of nanoscale and micron-scale roughness. The review concludes with the evaluation of clinical outcomes for implants with nanoscale surface modifications, such as the OsseoSpeed implant and the Nanotite implant. These studies demonstrate the potential of nanoscale surface modifications to enhance osseointegration and improve clinical outcomes in dental implant therapy.This review discusses the role of nanoscale topography in enhancing osseointegration of dental implants. The goal is to evaluate how nanoscale surface modifications of titanium substrates can improve bone integration. Nanotechnology offers new ways to interact with biological processes and has enabled understanding and achieving cell-specific functions. Various techniques can impart nanoscale topographic features to titanium endosseous implants. Existing data suggest that nanoscale modification can modulate critical steps in osseointegration. Important distinctions between nanoscale and micron-scale modifications are considered. The advantages and disadvantages of nanoscale modification are discussed. Available data on current dental implant surfaces using nanotopography in clinical dentistry are described. Nanoscale modification of titanium endosseous implant surfaces can alter cellular and tissue responses that may benefit osseointegration and dental implant therapy. The review highlights the significance of micron-scale topography in enhancing bone-to-implant contact. It discusses the biomechanical theory, contact osteogenesis, and surface signaling hypothesis. The role of surface roughness in osseointegration is explained, along with the effects of surface topography on cell behavior. The review also explores the application of nanotechnology to the dental implant surface, including nanoscale surface engineering and the use of nanoscale features to induce intrinsic osteoinductive signaling. The review discusses the effects of nanoscale topography on cell adhesion, proliferation, differentiation, and selectivity of adhesion. It also addresses the impact of nanoscale topography on the surface reactivity of the implant and the relative value of nanoscale and micron-scale roughness. The review concludes with the evaluation of clinical outcomes for implants with nanoscale surface modifications, such as the OsseoSpeed implant and the Nanotite implant. These studies demonstrate the potential of nanoscale surface modifications to enhance osseointegration and improve clinical outcomes in dental implant therapy.