<p>Titanium and its alloys are widely used in orthopedic and dental implants because of their high strength-to-weight ratio, excellent corrosion resistance, and biocompatibility. However, the performance of conventional titanium implants is often limited by bioinert surfaces, insufficient wear resistance, susceptibility to infection, and constraints associated with traditional manufacturing, such as material wastage and lengthy processing times. Additive manufacturing (AM) enables the production of patient-specific, porous titanium implants with enhanced mechanical compatibility. However, AM alone does not significantly improve surface bioactivity, antibacterial properties, or resistance to corrosion and wear. Plasma electrolytic oxidation (PEO) can generate protective, bioactive coatings on titanium surfaces, enhancing wear and corrosion resistance, biocompatibility, and antibacterial performance. The combination of AM and PEO offers a promising approach to overcoming the limitations of conventional titanium implants, enabling the development of next-generation devices with enhanced osseointegration, osteogenic activity, antibacterial functionality, and long-term durability. Despite advances in the field, comprehensive reviews addressing the relationship between the fabrication of AM titanium structures and subsequent PEO surface modification remain scarce, particularly regarding their combined effects on coating composition, structure, and biological performance. This review critically examines AM-fabricated titanium structures with PEO coatings, emphasizing the relationships among processing, structure, and biological and electrochemical performance. We believe this review will serve as a valuable reference for guiding future research and the rational design of advanced AM–PEO titanium implants.</p> Graphical Abstract <p></p>