The demand for biomaterials that promote the repair, replacement, or restoration of hard and soft tissues continues to grow as the population ages. Traditionally, smart biomaterials have been thought as those that respond to stimuli. However, the continuous evolution of the field warrants a fresh look at the concept of smartness of biomaterials. This review presents a redefinition of the term “Smart Biomaterial” and discusses recent advances in and applications of smart biomaterials for hard tissue restoration and regeneration. To clarify the use of the term “smart biomaterials”, we propose four degrees of smartness according to the level of interaction of the biomaterials with the bio-environment and the biological/cellular responses they elicit, defining these materials as inert, active, responsive, and autonomous. Then, we present an up-to-date survey of applications of smart biomaterials for hard tissues, based on the materials’ responses (external and internal stimuli) and their use as immune-modulatory biomaterials. Finally, we discuss the limitations and obstacles to the translation from basic research (bench) to clinical utilization that is required for the development of clinically relevant applications of these technologies.

随着人口老龄化，对促进硬组织和软组织修复、替换或恢复的生物材料的需求持续增长。传统上，智能生物材料被认为是对刺激做出反应的材料。然而，该领域的不断发展需要人们重新审视生物材料智能的概念。本综述重新定义了“智能生物材料”一词，并讨论了智能生物材料在硬组织修复和再生方面的最新进展和应用。为了阐明“智能生物材料”一词的使用，我们根据生物材料与生物环境的相互作用水平以及它们引起的生物/细胞反应提出了四个智能程度，将这些材料定义为惰性、活性、响应性，并且自主。然后，我们根据材料的反应（外部和内部刺激）及其作为免疫调节生物材料的用途，对智能生物材料在硬组织中的应用进行了最新调查。最后，我们讨论了从基础研究（实验）到临床应用转化的限制和障碍，这是开发这些技术的临床相关应用所需的。