Bioactive glass (BAG) and β-tricalcium phosphate (β-TCP) have emerged as promising biomaterials for bone substitution, particularly in the management of osteomyelitis, spondylodiscitis, pseudarthrosis, and prosthetic joint infections. Their osteoconductive, osteostimulatory, and antimicrobial properties have led to their increasing use as bone graft substitutes or adjuncts in the management of bone defects associated with fracture repair, pseudarthrosis, and infectious conditions such as acute and chronic osteomyelitis, typically in combination with standard surgical and antibiotic treatment strategies. This study presents a review with an updated evidence synthesis to evaluate the efficacy, clinical applications, and future perspectives of these materials. A narrative review was conducted, synthesizing evidence from in vitro, in vivo, and clinical studies that examined the use of BAG and β-TCP in bone regeneration and infection control. The review included studies assessing antimicrobial efficacy, bone remodeling potential, and clinical outcomes. Evidence indicates that BAG-45S5 and other types exhibit intrinsic antimicrobial properties, effectively reducing biofilm formation and multidrug-resistant bacterial growth. BAG-45S5 has the most extensive body of evidence, supporting the efficacy of its mechanism of action and its benefits for bone tissue. BAG combined with β-TCP enhances bone regeneration while promoting osteointegration. Clinical studies demonstrated high success rates in chronic and acute osteomyelitis and fracture healing, with reduced need for antibiotics. In conclusion, BAG and β-TCP represent a viable alternative to autografts, offering infection control and bone healing without donor site morbidity. Their integration into synthetic bone grafts and bioactive scaffolds suggests a transformative role in bone regeneration and orthopedic surgery.
Xiques-Molina et al. (2026) studied this question.