The implementation of 3D printing technology has led to rapid improvement in the performance of implants, particularly on Ti6Al4V alloys. This chapter focuses on the latest advancements and ongoing challenges in the 3D printing of textured Ti6Al4V alloy implants. The utilization of additive manufacturing techniques to texture implant surfaces is widely recognized for its ability to enhance implantation and impart essential mechanical and biological qualities for the feasibility and functionality of an implant. 3D printing provides very flexible preferences to customize the surface of an implant according to the specific desires of a patient, allowing for precise adaptation to complicated shapes and individual preferences. This analysis specifically examines the primary areas of advancement in optimizing printing parameters, post-processing procedures, and evaluating the mechanical properties of manufactured implants. The article inspects biological concerns associated with surface texturing on implants, particularly in relation to enhanced cell adherence, proliferation, and differentiation. An extensive analysis has been conducted on how the microstructural characteristics of alloys interact with the biological response. The purpose of this analysis is to emphasize the advancements made in creating a bioactive surface that closely resembles natural bone tissue. The paper studies the main difficulties related to balancing mechanical strength with bioactivity, the possibility of stress protection, and the durability of implants over time. This review also presents the latest advancements in multi-material printing and hybrid manufacturing, which allow for the utilization of several materials or procedures to overcome the constraints of individual methods and gain additional benefits.