Four-dimensional (4D) printing technology is based on 3D printing, it integrates time as the fourth dimension, enabling printed constructs to dynamically transform their shape or functionality in response to external stimuli. 4D printing utilizes intelligent materials as printing ink to enable bioactive scaffolds to respond dynamically to various stimuli over time, including physical factors such as temperature, light, electricity and chemical factors such as pH, along with biological factors like enzymes [
124,
126]. In comparison to traditional 3D printed scaffolds, the unique ability of 4D-printed scaffolds to change their properties under different stimuli makes them more intelligent in terms of programmed delivery of hydrogels and 3D-printed hydrogels [
124]. The key processes of 4D printing primarily involve the selection of materials and the conduct of external stimulations. The materials utilized in 4D printing must possess biocompatibility, encompassing not only biological inertness but also biostability and functional biological activity including the functional responsiveness under physiological conditions. Additionally, these materials should exhibit biodegradability, meaning they must be capable of breaking down under specific environmental conditions. Furthermore, printability is crucial as the fundamental structures of 4D printing materials are constructed using 3D printing technology. In addition to the aforementioned requirements, materials utilized in 4D printing should also possess properties such as shape memory, self-healing, and self-assembly. These characteristics are essential for achieving the complex deformation behaviors inherent to 4D printing and for forming ordered structures that can serve as fundamental components of shape memory materials [
127]. In addition to material composition, external stimuli should also be considered in 4D printing. The materials used in 4D printing are capable of altering their structural configurations in response to a variety of physical and chemical stimuli. These stimuli include, but are not limited to, temperature variations, magnetic fields, electric fields, light exposure, acoustic waves, pH levels, and changes in ionic concentrations, achieved through the incorporation of responsive units [
128]. Overall, the intelligent-response feature of 4D printings holds great promise for dynamically regulating IME suitable for infection clearance and creating osteoinductive microenvironments that adapt to changing stimuli over time. Five-dimensional (5D) printing introduces two additional rotational axes (total 5 axes) to the traditional 3D printing system, allowing curved-layer deposition and improved structural integrity [
129]. The printers of 5D printing, unlike the
x,
y, and
z axes of 3D printing, incorporate two additional axes to enhance structural integrity by enabling curved layers that are specifically designed for defect areas. This innovative approach enhances mechanical properties while optimizing material usage, making it particularly suitable for orthopedic applications because the human skeletal surface is not flat but curved. Meanwhile, the mechanical properties of implanted materials for load-bearing bones in IBD treatment have stringent requirements, which makes 5D printing a particularly promising technology that surpasses both 3D and 4D printing [
124,
130]. Six-dimensional (6D) printing represents an innovative concept that integrates the dynamic adaptability of 4D printing with the multi-axis capabilities of 5D printing, aiming to achieve real-time adaptation to intricate microenvironmental changes [
131]. Beyond printing along multiple axes, 6D printing emphasizes leveraging established 4D and 5D printing techniques to develop biomaterials capable of intelligent responses to environmental stimuli. Utilizing five degrees of freedom, it produces smart objects that can alter their shape or properties in response to external stimuli, while retaining the design flexibility characteristic of 5D printing materials [
129]. These attributes enable 6D printing materials to meet the complex shape requirements and stringent mechanical properties necessary for IBD treatment, intelligently responding to changes in the IBD environment. Consequently, this integration of 3D/4D/5D technologies yields superior treatment outcomes compared to individual printing methods. However, the widespread adoption of 6D printing has been impeded by manufacturing challenges, including the complexity of 6D printing equipment and its currently high cost, which future research should aim to address. Overall, as emerging technologies in printing, both 5D and 6D printing offer possibilities for enhancing the quality, programmability, and tunability of printed objects' multi-intelligent response to microenvironmental stimuli in IBD [
124]. The integration of artificial intelligence (AI) with immunomodulatory strategies offers a promising tool for personalized patient care [
132]. For instance, machine learning (ML) and deep learning (DL) techniques enable infection recognition, drug susceptibility analysis, and disease progression prediction in osteomyelitis [
133]. Meanwhile, it can also be applied in personalized diagnosis and treatment. The utilization of ML and DL presents immense potential in exploring the intricate interactions among pathogenic microorganisms, the immune system, and the skeletal system.