Bone regenerative medicine: classic options, novel strategies, and future directions This review analyzes the literature on bone grafts and introduces tissue engineering as a strategy in orthopedic surgery. It evaluates articles on bone grafts, analyzing their characteristics, advantages, and limitations, and explains bone-tissue engineering technologies. Many bone grafting materials are available to enhance bone healing and regeneration, from bone autografts to graft substitutes; they can be used alone or in combination. Autografts are the gold standard for this purpose, as they provide osteogenic cells, osteoinductive growth factors, and an osteoconductive scaffold, all essential for new bone growth. Autografts 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 is a new and developing option that has been introduced to reduce the limitations of bone grafts and improve the healing processes of bone fractures and defects. The combined use of scaffolds, healing promoting factors, together with gene therapy, and more recently, three-dimensional printing of tissue-engineered constructs may open new insights in the near future. Keywords: Bone graft, Tissue engineering, Regenerative medicine, Three-dimensional printing, Orthopedic research Bone grafts are defined as implanted materials that promote bone healing alone or in combination with other materials through osteogenesis, osteoinduction, and osteoconduction. The selection of an ideal bone graft depends on factors such as tissue viability, defect size, graft size, shape and volume, biomechanical characteristics, graft handling, cost, ethical issues, biological characteristics, and associated complications. The materials used in bone grafting can be divided into several major categories, including autografts, allografts, and xenografts. Synthetic and biologically based, tissue-engineered biomaterials and combinations of these substitutes are other options. Each of these options has advantages and disadvantages. Allografts and xenografts have osteoinductive and osteoconductive characteristics but lack the osteogenic properties of autografts. Autografts are the 'gold standard' in reconstructing small bone defects and have strong osteogenic characteristics relevant to bone healing, modeling, and remodeling. Pain and donor site morbidity as well as other risks such as major vessel or visceral injuries during harvesting are some of the disadvantages of autografts. For these reasons, several alternative options have been introduced and tested. Allografts are an alternative option with major limitations associated with rejection, transmission of diseases, and cost. Allografts have lower incorporating properties with the host healing tissues as compared with autografts. Xenografts, in addition to the disadvantages of allografts, carry the risks of transmission of zoonotic diseases, and rejection of the graft is more likely and aggressive. Given these problemsBone regenerative medicine: classic options, novel strategies, and future directions This review analyzes the literature on bone grafts and introduces tissue engineering as a strategy in orthopedic surgery. It evaluates articles on bone grafts, analyzing their characteristics, advantages, and limitations, and explains bone-tissue engineering technologies. Many bone grafting materials are available to enhance bone healing and regeneration, from bone autografts to graft substitutes; they can be used alone or in combination. Autografts are the gold standard for this purpose, as they provide osteogenic cells, osteoinductive growth factors, and an osteoconductive scaffold, all essential for new bone growth. Autografts 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 is a new and developing option that has been introduced to reduce the limitations of bone grafts and improve the healing processes of bone fractures and defects. The combined use of scaffolds, healing promoting factors, together with gene therapy, and more recently, three-dimensional printing of tissue-engineered constructs may open new insights in the near future. Keywords: Bone graft, Tissue engineering, Regenerative medicine, Three-dimensional printing, Orthopedic research Bone grafts are defined as implanted materials that promote bone healing alone or in combination with other materials through osteogenesis, osteoinduction, and osteoconduction. The selection of an ideal bone graft depends on factors such as tissue viability, defect size, graft size, shape and volume, biomechanical characteristics, graft handling, cost, ethical issues, biological characteristics, and associated complications. The materials used in bone grafting can be divided into several major categories, including autografts, allografts, and xenografts. Synthetic and biologically based, tissue-engineered biomaterials and combinations of these substitutes are other options. Each of these options has advantages and disadvantages. Allografts and xenografts have osteoinductive and osteoconductive characteristics but lack the osteogenic properties of autografts. Autografts are the 'gold standard' in reconstructing small bone defects and have strong osteogenic characteristics relevant to bone healing, modeling, and remodeling. Pain and donor site morbidity as well as other risks such as major vessel or visceral injuries during harvesting are some of the disadvantages of autografts. For these reasons, several alternative options have been introduced and tested. Allografts are an alternative option with major limitations associated with rejection, transmission of diseases, and cost. Allografts have lower incorporating properties with the host healing tissues as compared with autografts. Xenografts, in addition to the disadvantages of allografts, carry the risks of transmission of zoonotic diseases, and rejection of the graft is more likely and aggressive. Given these problems