Implant-associated infections remain among the most critical complications in orthopedic and dental implantology, frequently leading
to implant failure and necessitating revision surgery. These infections are particularly problematic during the early post-implantation
phase, when the host immune response and bone regeneration processes are not yet fully established. Bacterial adhesion and biofilm
formation during this vulnerable period highlight the importance of evaluating the intrinsic antibacterial properties of implant surfaces.
Additive Manufacturing (AM) has emerged as a transformative technology in implant fabrication, enabling the production of highly
complex, patient-specific three-dimensional structures with precisely controlled micro- and nano-topographies. However, the unique
surface architectures fabricated with AM, which are potentially important in modulating host responses and infection dynamics, are
not yet matched by in vitro evaluation systems capable of capturing such biologically relevant interactions. In particular, conventional
assays lack the capacity to simultaneously assess bacterial behavior and host cellular responses. In this study, we developed a novel in
vitro antibacterial evaluation platform incorporating a co-culture model of bacteria and primary osteoblasts, designed to better simulate
the early biological environment encountered by implants. We first established a quantitative bacterial colony counting method based on
image-based area correction and optimized both the bacterial seeding density and co-culture conditions to ensure reliable measurement
of bacterial proliferation and osteoblasts viability. The system was then applied to AM-fabricated titanium substrates with or without
unidirectional microgrooves. Under mono-culture conditions, bacterial viability did not differ significantly between groove and flat
substrates. In contrast, in the co-culture setting, only the groove substrates exhibited a marked antibacterial effect, characterized by
reduced bacterial survival alongside sustained osteoblasts morphology. This response was not detectable using conventional monoculture-
based assays. These findings indicate that the antibacterial performance of 3D-structured AM implants is highly contextdependent,
becoming apparent only under biologically relevant, cell-interactive conditions. The proposed co-culture model provides a
robust and physiologically meaningful platform for evaluating implant surface antibacterial properties, with significant implications for
the preclinical assessment of next-generation AM biomaterials.
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