The influence of surface roughness and the presence of adhesion molecules in the culture medium were studied regarding cell adhesion, shape, and proliferation of osteoblast-like cells grown on two types of titanium disk. Type I disks were acid etched and type II disks were sandblasted and acid etched. Surface roughness was determined by contact profilometry and scanning electron microscopy. Chemical composition and oxide thickness of the superficial titanium layer were established with energy dispersive X-ray spectrometry, electron spectroscopy for chemical analysis and auger electron spectroscopy. Titanium release in the culture medium was assessed by inductively coupled plasma-optical emission spectrometry. Osteoblast-like cells (Saos-2) were cultured on both types of titanium disks (1) in standard conditions (DMEM culture medium supplemented with fetal calf serum), (FCS), (2) with the culture medium alone (DMEM alone), (3) in the presence of fibronectin or vitronectin (DMEM supplemented with fibronectin or vitronectin). Cultures were also performed in the presence of monoclonal anti-integrin (beta1, alphav) to test the cell adhesion molecules involved in the cell binding to the titanium surface. We found that sandblasting does not modify the chemical surface composition and that titanium represents only 5-6% (in the atom percentage) of surface elements. Release of titanium in the culture medium was found to increase from 24 to 72 hours. In the absence of FCS, fibronectin, or vitronectin, cells appeared scanty and packed in clusters. On the contrary, cells cultured in the presence of FCS, fibronectin, or vitronectin were flattened with large and thin cytoplasmic expansions. The addition of anti beta1 or alphav integrin subunit monoclonal antibody in the culture medium decreased adhesion and spreading of cells, particularly in the presence of fibronectin. Cell proliferation was significantly higher on culture plastic than on both types of disks, but was increased on rough but not on smooth surfaces. These results indicate that a high surface roughness and presence of fibronectin or vitronectin are critical elements for adhesion, spreading, and proliferation of cells on titanium surfaces.