Osseointegration of metallic devices has shown to be successful in several biomedical fields. Despite the high success rates, continuous efforts to reduce osseointegration time have been marked by investigations considering a limited number of variables. Recent research has pointed that the interplay between surgical instrumentation and device macrogeometry not only plays a key role on both early and delayed stages of osseointegration but may also be key in how efficient smaller length scale designing (at the micro- and nanogeometrical levels) may be in hastening early stages of osseointegration. The present chapter focuses on how the different metallic device design length scales’ interplay (macro, micro, and nano) affects the bone response and how its understanding may affect the next generation of metallic device designing for osseointegration.