Titanium, PEEK or PMMA: choosing a patient-specific implant material
Patient-specific cranial and maxillofacial implants are made in three main materials: titanium, PEEK and PMMA. Each has a different balance of strength, imaging, contour, revision risk and cost. A bioresorbable PCL-TCP option is also available. This guide compares them and shows which material is usually chosen for each indication.
The three materials at a glance
| Titanium | PEEK | PMMA (prefabricated) | |
|---|---|---|---|
| Form | Thin perforated mesh or 3D-printed plate | Solid, machined to the defect | Solid, moulded to the defect |
| Strength | Highest; suits load-bearing sites | High; stiffness close to cortical bone | Moderate; more brittle |
| CT / MRI artefacts | Present | Minimal (radiolucent) | Minimal (radiolucent) |
| Heat conduction | Conducts heat | Low | Low |
| Cranioplasty revision rate (pooled) | About 13% | About 5% | About 9% |
| Relative cost | Moderate | Highest | Lowest |
Revision rates are pooled figures from a 2021 systematic review and network meta-analysis of cranioplasty materials in Neurosurgery (31 studies). Most included studies were observational, so the figures guide rather than decide the choice.
Titanium
Titanium (usually the alloy Ti-6Al-4V) is the strongest of the three for its thickness. A patient-specific titanium implant is supplied as a pre-contoured perforated mesh or as a 3D-printed plate, and porous lattice designs can support bone ingrowth. Titanium is the usual choice for load-bearing reconstruction such as the mandible, and thin titanium mesh is widely used for orbital floor and wall reconstruction. Its main drawbacks are imaging artefacts and heat conduction under thin scalp.
See also: 3D printed osseointegration titanium mesh.
PEEK
PEEK (polyether ether ketone) is a high-performance implantable polymer. A patient-specific PEEK implant is machined as one solid piece that reproduces the patient's contour closely, which makes it a strong choice for cranioplasty and for facial contouring of the zygoma and malar region. PEEK is radiolucent, light and does not conduct heat. In the 2021 meta-analysis it had the lowest pooled cranioplasty revision rate, although it has been linked to more subgaleal fluid collections after decompressive craniectomy.
For the full comparison, read PEEK vs titanium cranioplasty.
PMMA
PMMA (polymethyl methacrylate) has the longest history in cranioplasty. A prefabricated patient-specific PMMA implant is moulded from the CT-based design before surgery, which gives a better fit than hand-moulding in theatre. In the 2021 meta-analysis, prefabricated PMMA had a pooled revision rate of about 9%, compared with about 18% for hand-moulded PMMA. PMMA is radiolucent and the most economical patient-specific option, but it is more brittle than titanium or PEEK.
Bioresorbable PCL-TCP
PCL-TCP (polycaprolactone–tricalcium phosphate) is a biodegradable polymer–ceramic composite used for bioresorbable patient-specific implants, such as the Osteopore® PSI for cranioplasty. The implant is 3D-printed from the patient's CT as a porous scaffold whose interconnected architecture mimics cancellous bone and supports tissue and vascular ingrowth. It degrades by hydrolysis and resorbs fully over time while keeping its mechanical integrity during healing. A PCL-TCP implant is fixed with plates and screws, is compatible with permanent and bioresorbable fixation, and is used together with a bone graft or graft substitute. It is the option to consider when the goal is regeneration of the patient's own bone rather than a permanent implant.
Material selector by indication
| Situation | Usually considered | Why |
|---|---|---|
| Large cranial defect, cosmesis and follow-up imaging matter | PEEK | Exact contour, radiolucent, lowest pooled revision rate |
| Very large or complex cranial defect, strength first | Titanium | Highest strength in a thin form |
| Cranioplasty with a tight budget | Prefabricated PMMA | Lowest cost; better fit than hand-moulded PMMA |
| Orbital floor or wall | Titanium mesh | Thin, strong and contourable |
| Zygoma and malar contouring | PEEK | Solid, smooth contour; non-load-bearing site |
| Mandible reconstruction | Titanium | Load-bearing site needs metal strength |
| Regeneration preferred over a permanent implant | Bioresorbable PCL-TCP | Porous scaffold resorbs as bone regenerates |
| Patient needs regular CT or MRI follow-up | PEEK or PMMA | Minimal imaging artefact |
This table summarises common practice. The treating surgeon makes the final choice for each patient, and our team can share design options in more than one material for the same case.
Not sure which material fits your case?
Send the CT scan and we will return a design plan with material options from certified manufacturers, typically delivered across India 7 days from CT to delivery.
References
- Complications of cranioplasty in relation to material: systematic review, network meta-analysis and meta-regression. Neurosurgery. 2021;89(3):383–394. doi:10.1093/neuros/nyab180. PubMed
- Ji T, Yao P, Zeng Y, Qian Z, Wang K, Gao L. Subgaleal effusion and brain midline shift after cranioplasty: a retrospective study between polyetheretherketone cranioplasty and titanium cranioplasty after decompressive craniectomy. Front Surg. 2022;9:923987. Frontiers
This guide is for healthcare professionals and summarises published evidence and common practice. It is not a substitute for clinical judgement. Material selection is the decision of the treating surgeon.