Bacterial colonization in biomedical devices can lead to inflammation and bone loss, thereby compromising the implant's function. The emergence of multi-drug-resistant (MDR) bacteria, also known as superbugs, due to antibiotic abuse, further complicates and necessitates the exploration of innovative, versatile strategies. MXenes with multi-modal antimicrobial functionalities are promising two-dimensional (2D) materials for eliminating the complexities of biofilm, and for improving bone adhesion and tissue regeneration. However, methodologies for synthesizing MXenes are crucial to their performance, highlighting the need for further optimization. This review comprehensively explores MXene synthesis for biomaterial applications by analyzing their microbiological and biological properties while highlighting their potential to enhance osseointegration. To this end, a systematic search was performed, and 22 studies were identified that assessed at least one aspect related to the antibacterial activity, biocompatibility, cytotoxicity, or surface characterization of MXenes. The MXenes analyzed in this reviewâ€”Ti3AlC2, Mo2Ti2C3, and Nb2AlCâ€”exhibit the typical accordion-like morphology with ultrathin sheets. These materials possess intrinsic antimicrobial properties that inhibit bacterial growth and biofilm formation, which are further enhanced upon exposure to near-infrared (NIR) radiation. Moreover, MXenes exhibit biocompatibility, supporting cell adhesion, proliferation, and differentiation, as well as fostering osseointegration and bone regeneration. Despite these promising findings, the wide variability in synthesis methods and material compositions underscores the need for further clinical studies to enable the development of these materials into next-generation antimicrobial and bioactive coatings for biomedical implant applications. Â© 2025 Elsevier Ltd

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