From bone replacement to regeneration. A biomaterials started journey

Over the past decades, strategies for skeletal repair have undergone a significant transformation, shifting from inert structural replacements to advanced systems capable of actively promoting bone regeneration. Early biomaterials, including metals and bioinert ceramics, were designed primarily to provide mechanical support with limited biological interaction. With increasing knowledge of bone physiology and healing processes, bioactive and osteoconductive materials such as hydroxyapatite and calcium phosphate ceramics emerged to enhance integration and stimulate new tissue formation. Modern regenerative biomaterials are now engineered to emulate essential features of the extracellular matrix, deliver precisely controlled biological cues, and interact dynamically with cells to drive osteogenesis, angiogenesis, and tissue remodeling. Biomaterial-based approaches help overcome the major drawbacks of autografts and allografts, including donor-site complications, restricted supply, and immunological concerns. Advances in polymers, ceramics, hydrogels, and composite scaffolds, together with emerging technologies such as 3D bioprinting and controlled growth factor delivery, allow improved regulation, and direct comparison, of mechanical performance, degradation behaviour, and bioactive signalling. This broader perspective is further strengthened by the integration of key aspects of biomaterial-clinical translation, including major translational barriers, current clinical outcomes, and structured pathways. As the field approaches a pivotal stage, continued progress will rely on interdisciplinary collaboration, standardized and reproducible methodologies, scalable production, and data-driven design strategies. These developments position biomaterials science as a key driver in achieving reliable and functional bone regeneration.