Multidimensional biomimetic strategies for artificial bone scaffolds in bone defect repair

Background Critical-sized bone defects remain a major challenge in orthopedic practice. Biomimetic scaffolds are designed to support bone regeneration by reproducing the structural and functional characteristics of native bone. Objective To synthesize advances in multidimensional biomimetic bone scaffolds, examine their roles in bone regeneration, and identify key barriers to clinical translation. Methods This narrative review drew primarily on literature identified through PubMed and Google Scholar, with an emphasis on publications from the past five years. Representative original studies and reviews were selected based on their relevance to biomimetic scaffold design, regenerative mechanisms, pathological bone defects, and fabrication technologies. Earlier publications were included where needed to provide foundational context. The selected literature was synthesized thematically across complementary aspects of scaffold design and application. Results The synthesis integrates five interconnected design dimensions: composition, hierarchical structure, mechanical properties, biophysical signaling, and biological regulation. These dimensions link scaffold design to controlled drug delivery, reconstruction of a vascularized microenvironment, and neuro-osseous coupling. Preclinical studies report promising regenerative outcomes in models of infected, post-tumor-resection, and diabetic bone defects. Three-dimensional printing, electrospinning, and self-assembly offer complementary fabrication approaches for implementing these strategies across diverse material classes. However, limited clinical evidence and unresolved challenges in long-term biosafety, mechanical compatibility, functional stability, and reproducible, patient-specific manufacturing continue to hinder translation. Conclusion Multidimensional biomimetic design provides a framework for coordinating structural support with biological regulation during bone repair. Further progress requires validation of long-term safety and functional performance, alongside manufacturing approaches that balance functional complexity with clinical feasibility.