This review examines the literature on bone grafts and introduces tissue engineering as a strategy in orthopedic surgery. It evaluates articles concerning bone grafts, analyzing their characteristics, advantages, and limitations. The review highlights the use of autografts, allografts, and xenografts, each with its own set of benefits and drawbacks. Autografts are considered the gold standard due to their osteogenic, osteoinductive, and osteoconductive properties, but they have limitations such as morbidity at the harvesting site and limited availability. Allografts and xenografts carry the risk of disease transmission and rejection. Tissue engineering, a new and developing field, aims to reduce these limitations by using scaffolds, growth factors, and stem cells to improve bone healing and regeneration. The review discusses the structure and properties of different types of bone grafts, including cortical, cancellous, and cortico-cancellous grafts, and their incorporation into the recipient bone. It also explores the immune response to bone grafts and substitutes, highlighting the role of macrophages and lymphocytes in graft acceptance or rejection. The review concludes by discussing the latest advancements in tissue engineering, including the use of synthetic and biologically based biomaterials, three-dimensional printing, and the combination of scaffolds with gene therapy to enhance bone regeneration.This review examines the literature on bone grafts and introduces tissue engineering as a strategy in orthopedic surgery. It evaluates articles concerning bone grafts, analyzing their characteristics, advantages, and limitations. The review highlights the use of autografts, allografts, and xenografts, each with its own set of benefits and drawbacks. Autografts are considered the gold standard due to their osteogenic, osteoinductive, and osteoconductive properties, but they have limitations such as morbidity at the harvesting site and limited availability. Allografts and xenografts carry the risk of disease transmission and rejection. Tissue engineering, a new and developing field, aims to reduce these limitations by using scaffolds, growth factors, and stem cells to improve bone healing and regeneration. The review discusses the structure and properties of different types of bone grafts, including cortical, cancellous, and cortico-cancellous grafts, and their incorporation into the recipient bone. It also explores the immune response to bone grafts and substitutes, highlighting the role of macrophages and lymphocytes in graft acceptance or rejection. The review concludes by discussing the latest advancements in tissue engineering, including the use of synthetic and biologically based biomaterials, three-dimensional printing, and the combination of scaffolds with gene therapy to enhance bone regeneration.