PATIENT-SPECIFIC CRANIOPLASTY IN THE ADDITIVE-MANUFACTURING ERA: COMPARATIVE EVALUATION OF PEEK, TITANIUM, PMMA, AND REGENERATIVE POROUS IMPLANTS

Аннотация

Background. Patient-specific cranioplasty has evolved from intraoperative manual contouring toward computed-tomography-based design, additive manufacturing, and biologically informed implant architecture. Material selection remains controversial because geometric accuracy does not automatically ensure infection resistance, soft-tissue compatibility, mechanical durability, or osseointegration.

Materials and methods. Randomized trials, prospective cohorts, retrospective comparative studies, biomechanical investigations, additive-manufacturing studies, and clinical series published through July 2026 were synthesized. Evidence was organized according to defect geometry, implant accuracy, mechanical and thermal behavior, imaging compatibility, infection, exposure, fluid collection, manufacturing workflow, cost, and biological integration.

Results. Patient-specific PEEK provides accurate contour reconstruction, low weight, favorable imaging characteristics, and bone-like elastic behavior, but remains bioinert and may be associated with subgaleal or epidural fluid collections. Titanium offers high mechanical strength, thin-profile fabrication, reliable fixation, and opportunities for porous osseointegrative architecture, but produces imaging artifacts and may be vulnerable to thermal discomfort or exposure under compromised scalp. PMMA remains accessible, modifiable, and cost-effective, particularly when manufactured with three-dimensional printed molds; limitations include exothermic polymerization, brittleness, residual monomer, and inconsistent tissue integration. Porous hydroxyapatite, calcium-phosphate–titanium composites, and experimental porous titanium or functionalized polymer implants seek progressive bone ingrowth and vascular integration, but clinical evidence remains heterogeneous and long-term explantability requires consideration.

Conclusion. No universally superior cranioplasty material exists. The proposed CRANIO-MAP framework links wound biology, defect geometry, soft tissue, cerebrospinal-fluid dynamics, imaging requirements, mechanical demands, manufacturing logistics, biological integration, and patient priorities to implant selection.