In this study, the effects of sterilization and water rinsing on cell adhesion to titanium (Ti) surfaces were investigated. Ti substrates were treated using autoclave, dry-heating, and 70% ethanol. Thereafter, some of the substrates were rinsed with sterilized ultrapure water. Osteoblast-like MC3T3-E1 cells were seeded on the Ti surfaces and the numbers of adhered cells were counted after cultivation for 24 h. The number of cells adhered to ethanol-treated plates was lower than that on autoclave- and dry-heat-sterilized Ti substrates. However, interestingly, the cell adhesion performance on the ethanol-treated substrates was superior compared to that of the other substrates, after rinsing with ultrapure water. To investigate the origin of these differences, the chemical state of the treated surfaces was analyzed by X-ray photoelectron spectroscopy. We found a clear correlation between the number of adhered cells and the concentration of hydroxide groups (OH-) on the surface, thus indicating that a change in OH- concentration affects the cell adhesion performance on Ti substrates. Since the sterilization and subsequent water rinsing affect the cell adhesion on Ti substrates, we suggest that the sterilization methods should be unified to correctly evaluate the cytocompatibility of metallic materials. (C) 2014 Published by Elsevier B.V.