Mastoid Obliteration Using Bioceramic Scaffold After Canal Wall Down Mastoidectomy: A Systematic Review

Canal wall down mastoidectomy (CWD) effectively eradicates cholesteatoma and chronic otitis media but frequently results in a problematic open mastoid cavity. Mastoid obliteration aims to reduce cavity-related morbidity. Bioceramic materials, including hydroxyapatite (HA), tricalcium phosphate (TCP), and bioactive glass (BAG), have been increasingly adopted because of their osteoconductive, biocompatible, and antimicrobial properties. This systematic review evaluates the clinical outcomes and complications of bioceramic mastoid obliteration following CWD. A systematic literature search of PubMed, Scopus, and Web of Science was conducted for studies published between 2005 and 2025, following PRISMA guidelines. Clinical studies reporting outcomes of bioceramic mastoid obliteration after CWD were included. Thirteen clinical studies were included. HA-, TCP-, and BAG-based materials demonstrated high obliteration success rates (>90% in most series). BAG S53P4 was consistently associated with low infection rates and favorable epithelialization, whereas earlier HA cement formulations were occasionally associated with revision-requiring complications. Bioceramic scaffolds represent safe and effective materials for mastoid obliteration after CWD. BAG offers additional antibacterial advantages, while HA provides predictable volume stability. Further prospective and comparative studies are required to establish material superiority and long-term outcomes.