Dental implant failure cannot always be explained by clinical risk factors. Recent literature suggests that immune cells are pivotal players in the integration of biomaterials and have a co-relationship within a set of osteal macrophages known as "OsteoMacs." These cells have been known to polarize quickly between a M1 pro-inflammatory and a M2 wound healing state during implant osseointegration. OsteoMacs play a critical immune surveillance role in the osseointegration of dental implant healing and bone homeostasis. This review is intended to provide an overview of the current understanding of OsteoMacs and their role in early implant failure and osseointegration.