The formation of bacterial biofilm on the surface of implanted metal objects is a major clinical problem. The antibacterial and antifungal effect of silver ions has been long known, and seems to give silver the capability to inhibit biofilm formation. To test the effect of silver ions, 20 New Zealand rabbits had bacteria applied to a screw insertion site at the iliac crest, and were then randomly divided into two groups: Group I, which had silver-coated screws applied, and Group II, which had uncoated titanium screws. After the rabbits were sacrificed on day 28, we examined the screws, the bone adjacent to the screws, and the liver, kidneys, brain and corneas of both groups under transmission (TEM) and scanning electron microscopy (SEM). We also analysed microbiological samples from the screw holes. All silver-coated screws, but only 10% of uncoated titanium screws, were sterile. All tissue samples appeared ultrastructurally normal in both groups. Biofilm formation was inhibited on all silver-coated screws, but all uncoated screws developed a biofilm on their surfaces. Our findings suggest that nanoparticle silver ion-coated implants are as safe as uncoated titanium screws and that they can help prevent both biofilm formation and infection. (C) 2010 Elsevier Ltd. All rights reserved.