Bio-activation of titanium surface by Na plasma immersion ion implantation and deposition (PIII and D) is illustrated by precipitation of calcium phosphate and cell culture. The bioactivity of the plasma-implanted titanium is compared to that of the untreated, Na beam-line implanted and NaOH-treated titanium samples. Our data show that the samples can be classified into two groups: non-bioactive (untreated titanium and beam-line Na implanted titanium) and bioactive (Na-PIII and D and NaOH-treated titanium). None of the four types of surfaces exhibited major cell toxicity as determined by lactate dehydrogenase (LDH) release. However, the LDH release was higher on the more bioactive PIII and NaOH-treated surfaces. From a morphological point of view, cell adherence on the NaOH-treated titanium is the best. On the other hand, the cell activity and protein production were higher on the non-bioactive surfaces. The high alkaline phosphatase activity per cell suggests that the active surfaces support an osteogenic differentiation of the bone marrow cells at the expense of lower proliferation. The use of Na-PIII and D provides an environmentally cleaner technology to improve the bioactivity of Ti compared to conventional wet chemical processes. The technique is also particularly useful for the uniform and conforming treatment of medical implants that typically possess an irregular shape and are difficult to treat by conventional ion beam techniques.