A systematic review of carbonate apatite (CO₃Ap) in bone reconstructive surgery and tissue engineering is presented. CO₃Ap, a calcium phosphate ceramic, has gained attention for its excellent biocompatibility, resorbability, and osteoconductivity. It closely resembles natural bone and causes minimal immunological reactions, making it suitable for applications such as bone substitution, scaffolding, implant coating, drug delivery, and tissue engineering. Eighteen studies were included in the review, showing that CO₃Ap has superior biological properties compared to hydroxyapatite (HA) and β-tricalcium phosphate (β-TCP). It promotes faster bone regeneration and has better osteoconductivity, with studies indicating its potential for use in bone remodeling and tissue engineering. CO₃Ap has been approved for clinical use in Japan and has shown promising results in clinical trials, including in sinus floor elevation and implant placement. It has also been used in composite materials with polymers, collagen, and chitosan, demonstrating improved properties. However, CO₃Ap has limitations, including poor mechanical properties and rapid solubility, which may be addressed through physicochemical modifications. Future research should focus on improving fabrication techniques, evaluating its safety and efficacy in human trials, and exploring its potential in various biomedical applications. The review concludes that CO₃Ap is a promising material for bone reconstructive surgery and tissue engineering, with potential for further development and clinical application.A systematic review of carbonate apatite (CO₃Ap) in bone reconstructive surgery and tissue engineering is presented. CO₃Ap, a calcium phosphate ceramic, has gained attention for its excellent biocompatibility, resorbability, and osteoconductivity. It closely resembles natural bone and causes minimal immunological reactions, making it suitable for applications such as bone substitution, scaffolding, implant coating, drug delivery, and tissue engineering. Eighteen studies were included in the review, showing that CO₃Ap has superior biological properties compared to hydroxyapatite (HA) and β-tricalcium phosphate (β-TCP). It promotes faster bone regeneration and has better osteoconductivity, with studies indicating its potential for use in bone remodeling and tissue engineering. CO₃Ap has been approved for clinical use in Japan and has shown promising results in clinical trials, including in sinus floor elevation and implant placement. It has also been used in composite materials with polymers, collagen, and chitosan, demonstrating improved properties. However, CO₃Ap has limitations, including poor mechanical properties and rapid solubility, which may be addressed through physicochemical modifications. Future research should focus on improving fabrication techniques, evaluating its safety and efficacy in human trials, and exploring its potential in various biomedical applications. The review concludes that CO₃Ap is a promising material for bone reconstructive surgery and tissue engineering, with potential for further development and clinical application.