Increased surface roughness of dental implants enhances the process of osseointegration. It increases bone conduction and increases BIC in all types of bone, resulting in elevated removal torque values. Surface roughness elevated the CSR of implants implanted in adverse conditions as augmented ridges and sinuses and areas of poor bone, such as the posterior maxilla, and in some cases abolished the deleterious effect of smoking. A growing number of clinical studies suggest that early and immediate loading of rough-surfaced implants may lead to predictable osseointegration. However, it is important to note that these studies provide short-term results based on radiographic observation and clinical mobility only. Before we adopt new surgical and prosthetic guidelines, longer and broader studies are needed. Most recent research has examined the effect of surface roughness on bone healing around implants in vivo and the influence of surface roughness on osteoblasts in vitro. In a study just published, it was found that changing the surface chemistry by submerging an implant in an isotonic sodium chloride solution following acid etching to avoid contamination with molecules from the atmosphere significantly increased osteoblast differentiation in vitro and BIC in vivo. This finding may lead us to a new era in dental implants.