Advances in Materials and Technologies for Cranioplasty: A Narrative Review

Cranioplasty is a key reconstructive procedure for restoring cranial integrity, protecting intracranial structures, and enhancing neurological, psychological, and aesthetic outcomes after skull defects. At present, the selection of repair material remains clinically challenging, given that no single material comprehensively fulfills the requirements of mechanical stability, biocompatibility, osseointegration, imaging compatibility, infection resistance, cost-effectiveness, and long-term safety. This review summarizes current advances in cranioplasty materials, encompassing autologous bone, titanium, polymethyl methacrylate, polyether ether ketone, degradable polymers, bioceramics, and bioactive composite scaffolds. Conventional materials remain widely utilized owing to their established clinical performance. However, their applications are limited by several complications. These include bone resorption, infection, implant exposure, mechanical mismatch, and insufficient biological integration. Recent advances have been made in CAD/CAM, three-dimensional printing, surface modification, controlled delivery of bioactive factors, and tissue-engineered scaffolds. These advances have promoted a shift from passive defect coverage toward patient-specific and regenerative reconstruction strategies. However, most emerging strategies are primarily supported by preclinical or heterogeneous clinical evidence. Future studies should prioritize indication-based material selection, standardized outcome assessment, long-term follow-up, and multicenter validation to guide the development of safer and more functional cranioplasty materials. This narrative review was based on a targeted literature search of Google Scholar, PubMed/MEDLINE, Web of Science, Scopus, with an emphasis on recent clinical evidence and emerging translational strategies for materials used in cranial defect repair.