Abstract
Bone tissue engineering has witnessed a historical shift from three perspectives. From a biomaterial perspective, materials have now become smarter and dynamic; from a bioengineering perspective the bioprinting techniques have now advanced to 4D bioprinting; and from a clinical perspective scaffold bioactivity has progressed toward enhanced osteoinductive scaffolds driven by intricate biomechanical, biophysical, biochemical, and biological cues. Though all of these advancements are indicative of improvised scaffold engineering, a pivotal question regarding the critical role and need of designing and replicating the intricacies of trabecular microarchitecture for enhanced, clinically appreciable osteoangiogenicity needs to be answered. This review hence critically evaluates the rationale and the need of investing substantial effort into designing complex microarchitectures amidst the era of "smart biomaterials" and dynamic 4D bioprinting aimed toward enhancing clinically appreciable bioactivity. The article explores the concept of integrating intricate designs into a scaffold microarchitecture to bolster bioactivity and the practical challenges encountered in 3D bioprinting of complex designs and meticulously examines the pivotal role of biomaterials in scaffold bioactivity, proposing a comprehensive approach to bioprinting geared toward achieving clinical bioactivity and striking a judicious balance between design intricacy and functional outcomes in bone bioprinting.