between the ability of an implant surface to resist bacterial adhesion, to its capacity to encourage tissue integration and even stimulate specific cellular responses . The phrase "race for the surface" describes the fate of a successful implant procedure (i.e. the possibility of preventing biomaterial-related infections) in terms of a contest between the host tissue cell integration and bacterial adhesion to the implant surface. This concept, largely credited to Anthony Gristina and is now widely accepted in the field of biomaterial, relates incidents of biomaterial-associated infections and/ or the lack of tissue integration to the initial bacterial colonization of the implant surface . This theory has been experimentally studied, and it was demonstrated that the competition for attachment on the implant surface between the desirable host cells and bacteria depends strongly on the amount of initial bacteria on the surface . Therefore it has become necessary for biomaterials to undergo surface modification capable of multifunctional abilities, such as to resist bacterial adhesion while simultaneously facilitating host cell integration . Surface modification of implant material is not a recent endeavor; simple techniques like mechanical polishing, grinding, and blasting, which introduce some form of topographical changes with inhomogeneous micrometric features, have been investigated for their ability to improve osseointegration . These procedures, while being a straightforward modification approach, will be limited in their efficiency because it has been shown that interaction between a biomaterial and host tissue occurs at the nanoscale, therefore control can be optimized by nanoscale modification . An effective method for nanoscale modification of biomaterial is by coating with nanoporous/nanotubular structures of metal oxides and such structures have received attention due to their chemical stability, good wettability, mechanical strength, and biocompatibility . Such coating can fit suitably to the multifunctional requirement of biomaterial for implants by the possibility to load the inner volume with various therapeutic agents including antibiotics that can be released in a controlled manner. Furthermore, nanoscale morphology has been shown to affect cell behavior as they can be modified to selectively attach to the desired host tissue . These nanostructures can be fabricated by a relatively simple straightforward electrochemical anodization in a fluoride-containing electrolyte . Nanoporous/nanotubular structures of titania and zirconia synthesized via anodization with good control over their dimension and geometry have been investigated as a potential delivery coating on implants . Titanium and zirconia-based materials have already been widely used in fabricating implant devices mostly for orthopedic and dental applications due to their mechanical strength, good corrosion resistance, and biocompatibility . Attempts at enhancing the antibacterial properties of zirconia and titania nanotube coatings entailed multistep of initially fabricating the nanotube before loading with antibiotics and the release studies investigated . These various studies have shown good promise for example Popat et al. loaded titania nanotubes with Gentamicin and showed a reduced bacterial adhesion and enhanced osteoblast differentiation on the nanotube filled with gentamicin . However, the drawback of simply loading with antibiotics that mostly are physisorbed on nanotubes is the problem of toxicity, sometimes due to initial burst release; a characteristic release behavior from such media, and a lack of long-term antibacterial properties. Efforts at impacting a seemly longer antibacterial property have involved an additional step of coating with biopolymer or polymer brush coating . While this approach can increase the release time there is the worry of introducing extra material in the fabrication process which in addition to increased cost, the differences in material properties (i.e. mechanical strength) can restrict its application. Furthermore, there is always the problem of degrading of the polymer over time . Loading with Silver nanoparticles has also attracted interest, as the use of organic antibiotics has the problem of a limited range of antimicrobial activities and in some instances ineffective due to antibiotic resistance development . Silver (Ag) salt and nanoparticles have demonstrated a broad spectrum of antibacterial properties and are currently being used in a variety of medical devices/materials to prevent bacterial infections . Several techniques such as chemical reduction , silanization , photo-reduction , etc have been investigated for incorporating Ag with nanotubes, while these methods enhanced the antibacterial properties of the nanomaterial, there have been reports of cytotoxicity connected with such systems due to high initial release of Ag nanoparticles. Furthermore, these methods require a longer time, and can be complex; in particular, the Ag loading process requires also other materials for optimization .