Cranioplasty in the 21st Century: Bridging Neurosurgery, Biomaterials, and Regenerative Frontiers

Abstract Cranioplasty restores skull integrity following trauma, decompression, tumor removal, or congenital deformity. Choosing the right implant material is crucial for structural protection and aesthetic durability. Available materials include autologous bone, metals, polymers, and composites—each with distinct advantages and limitations. Advances in materials science and manufacturing have introduced technologies such as patient-specific 3D printed implants, bioactive ceramics, and regenerative scaffolds. A narrative review of studies published between 2005–2025 on PubMed, Scopus, and Web of Science identified studies on “cranioplasty,” “biomaterials,” and materials such as polymethyl methacrylate (PMMA), titanium, and polyetheretherketone (PEEK). Data on biomechanics, biological response, infection, failure, imaging compatibility, cost, and usability were extracted. Current cranioplasty practice relies on few established materials. Autologous bone provides perfect anatomical match but risks resorption and infection, especially in children. PMMA is inexpensive, rigid, and radiolucent but brittle and biologically inert. Titanium offers strength and low infection rates but is costly and unsuitable for growing skulls. PEEK closely mimics bone elasticity and imaging transparency, giving excellent aesthetics but high expense and poor osseointegration. Emerging solutions, such as 3D printing, hydroxyapatite (HA) ceramics, and regenerative constructs, aim to improve integration and reduce complications. There is no universal ideal material. Selection should depend on patient age, defect characteristics, infection, and resources. While autologous bone remains preferred when feasible, PMMA, titanium, and PEEK each offer advantages. Ongoing development of bioactive and regenerative implants represents the future of personalized cranial reconstruction.