Mechanism of action of bioceramics on the promotion of bone formation.

Bioceramic	Formula	Pathway	Effect on bone formation/metabolism	Ref.
Hydroxyapatite (HA)	Ca10 (PO4)6(OH)2	ERK/Sox9, BMP/Smad, Wnt, MAPK, Notch	• Induces in vivo bone matrix mineralization, and enhances bone-implant osteointegration	74–78
			• Achieves superior bone quality and prevents fibrous healing of bone
β-Tricalcium phosphate (β-TCP)	Ca3(PO4)2	BMP	• Full thickness bone ingrowth and well vascularized bone tissue	79
Bisphosphonate (BP)	(PO(OH)2)	RANK	• Increase bone density, which leads to a better bone integration	80–84
			• Improved bone mass, trabecular architecture promoted apoptosis of osteoclasts thereby reducing bone resorption
Akermanite	Ca2MgSi2O7	MAPK	• Increased osteoblastic activity as indicated by higher osteoid secretion	85
			• Good osteointegration
Bioactive glass	45S5 Bioglass®-45% silica (SiO2), 24.5% calcium oxide (CaO), 24.5% sodium oxide (Na2O), and 6% phosphorous pentoxide (P2O5)	MAPK	• Robust in vivo bone in growth throughout the porous scaffold while maintaining bone-material contact without ectopic bone formation	86 and 87