Comparative Safety and Efficacy of Patient-Specific Versus Hand-Molded Implants in Cranioplasty: A Systematic Review and Meta-Analysis

<b>Background/Objectives:</b> Cranioplasty (CP) is associated with high complication rates (20-50%), and the optimal choice between patient-specific implants (PSIs) and hand-molded (HM) alternatives remains debated. This systematic review and meta-analysis aims to compare surgical and postoperative outcomes between PSIs and HM implants. <b>Methods:</b> A systematic search was performed in three databases to identify studies reporting surgical site infection (SSI), implant removal, reoperation, operative time or cosmetic outcome for PSIs and/or HM implants. Two-arm studies of the same material were analyzed separately from pooled single- and two-arm studies. <b>Results:</b> 125 observational studies involving 10,034 patients were included. In two-arm comparisons, PSIs reduced implant removal for titanium (OR 0.34, <i>p</i> = 0.053) and PMMA (OR 0.56, <i>p</i> = 0.188), while SSI rates showed no meaningful difference between groups. In one-arm analyses, PSIs demonstrated lower explantation probabilities (titanium 6.1%, PMMA 7.9%) compared with HM alternatives (titanium 9.9%, PMMA 14.2%), alongside shorter operation times and fewer reoperations. Cosmetic outcomes consistently favored PSIs. <b>Conclusions:</b> PSIs demonstrate advantages in efficiency, durability, and esthetics compared with HM implants, supporting their preferential use where resources allow. HM implants remain a cost-effective option in resource-limited settings. Due to the observational nature of the included studies and differences in study populations across arms, the findings should be interpreted with caution.