Additive manufacturing (AM) offers the unique capability of directly creating three-dimensional complicated ceramic components with high process flexibility and outstanding geometry controllability. However, current ceramic AM technology is mainly limited to the creation of a single material, which falls short of meeting the multiple functional requirements under increasingly harsh service circumstances. Ceramic multi-material additive manufacturing (MMAM) technology has great potential for integrally producing multi-dimensional multi-functional components, allowing for point-by-point precision manufacturing of programmable performance/functions. However, there is a huge gap between the capabilities of the existing ceramic MMAM technology and the requirements for industrial application. In this review, we discuss and summarize the research status of ceramic MMAM technology from the perspectives of feedstock selection, printing process, post-processing, component performance, and application. Throughout the discussion, the challenges associated with ceramic MMAM such as heterogeneous material coupled printing, heterogeneous interfacial bonding, and co-sintering densification have been put forward. This review aims to bridge the gap between AM technologies and the requirements for multifunctional ceramic components by analyzing the existing limitations in ceramic MMAM and pointing out future needs.

Piezoelectricity in native bones has been well recognized as the key factor in bone regeneration. Thus, bio-piezoelectric materials have gained substantial attention in repairing damaged bone by mimicking the tissue’s electrical microenvironment (EM). However, traditional manufacturing strategies still encounter limitations in creating personalized bio-piezoelectric scaffolds, hindering their clinical applications. Three-dimensional (3D)/four-dimensional (4D) printing technology based on the principle of layer-by-layer forming and stacking of discrete materials has demonstrated outstanding advantages in fabricating bio-piezoelectric scaffolds in a more complex-shaped structure. Notably, 4D printing functionality-shifting bio-piezoelectric scaffolds can provide a time-dependent programmable tissue EM in response to external stimuli for bone regeneration. In this review, we first summarize the physicochemical properties of commonly used bio-piezoelectric materials (including polymers, ceramics, and their composites) and representative biological findings for bone regeneration. Then, we discuss the latest research advances in the 3D printing of bio-piezoelectric scaffolds in terms of feedstock selection, printing process, induction strategies, and potential applications. Besides, some related challenges such as feedstock scalability, printing resolution, stress-to-polarization conversion efficiency, and non-invasive induction ability after implantation have been put forward. Finally, we highlight the potential of shape/property/functionality-shifting smart 4D bio-piezoelectric scaffolds in bone tissue engineering (BTE). Taken together, this review emphasizes the appealing utility of 3D/4D printed biological piezoelectric scaffolds as next-generation BTE implants.