Evidence guide
PEEK vs titanium cranioplasty: what the research says
PEEK and titanium are the two most widely used materials for custom skull implants. Here is how they compare in published studies, including where the studies disagree.
The short answer
- Neither material is clearly better on every outcome.
- Several analyses found titanium linked to fewer blood clots after surgery and better fit, but more cases of the implant showing through the scalp.3,7
- Several analyses found PEEK linked to fewer overall complications and fewer repeat operations than titanium.1,2,4
- Infection rates overlap, and individual hospitals report very different numbers.5,8
- Nearly all of the evidence comes from looking back at past cases, not from randomized trials.
Disclosure. The author of this site works for a company that makes titanium cranial implants. This page reports every relevant finding we found, including those that favor PEEK. See About for more.
The two materials in brief
- PEEK (polyetheretherketone) is a high-performance medical plastic. Cranial PEEK implants are made to fit each patient from a CT scan, by machining or 3D printing.
- Titanium is a strong, lightweight metal. Cranial titanium comes as flat mesh the surgeon shapes during surgery, or as a patient-specific implant that is milled or 3D printed from a CT scan.
The main guide has a fuller overview of every implant material.
Side by side
| Outcome | What studies found | Source |
|---|---|---|
| Overall complications | Lower with PEEK than titanium (odds ratio 0.51). In another analysis, pooled rates were 18.5% for PEEK and 26.1% for titanium. | 1, 4 |
| Repeat surgery | PEEK 5% vs titanium 13% in one network analysis. Failure rates of 6.3% for PEEK and 11.4% for titanium in another. | 2, 4 |
| Implant exposure | Higher with titanium. Titanium vs non-titanium odds ratio 4.11; PEEK vs titanium 0.17. | 3, 1, 7 |
| Blood clots (hematoma) | Lower with titanium than non-titanium implants (odds ratio 0.31). No difference between PEEK and titanium in another analysis. | 3, 1 |
| Fit problems | Lower with titanium than non-titanium implants (odds ratio 0.35). | 3 |
| Infection | No significant difference in two analyses. In a 2025 review of custom implants: titanium 8.2%, PEEK 11.1%. | 1, 5, 7 |
| Implant removal | Similar in the same 2025 review: titanium 3.7%, PEEK 3.8%. | 5 |
Where PEEK has looked better
- Fewer overall complications and less exposure. A 2020 meta-analysis found PEEK had about half the odds of any complication and much lower odds of implant exposure compared with titanium, with no difference in infection or blood clots.1
- Fewer repeat operations. A 2021 network meta-analysis found PEEK had the lowest revision rate of any material, 5%, against 13% for titanium.2
- Imaging. PEEK is a plastic that X-rays pass through, so it doesn't create the image artifact that metal can on CT scans.
Where titanium has looked better
- Fewer blood clots and fit problems. A 2021 meta-analysis of 2,258 procedures found titanium linked to fewer overall complications than non-titanium implants, including fewer hematomas and fit problems.3
- Patient-specific 3D-printed titanium. A 2025 meta-analysis found 3D-printed titanium implants had far fewer total complications than standard implants (odds ratio 0.26). 3D-printed PEEK showed no difference from standard implants.6
- Imaging. Titanium does cause some CT artifact, though one study of 3D-printed titanium mesh found image quality near the implant was not significantly worse overall.9
The consistent concern with titanium is exposure, where the scalp wears thin over the implant and it shows through.3,7 That is one reason surgeons look closely at scalp thickness and past wound problems when choosing a material.
Why the studies disagree
- Mostly backward-looking studies. Patients weren't randomly assigned a material, so differences may reflect who received which implant.
- Follow-up length differs. The 2025 review noted titanium studies had shorter follow-up than others, which may underestimate titanium infection rates.5
- Results vary a lot by hospital. One two-center German series reported infection in 28.6% of PEEK implants, far above pooled averages.8
- "Titanium" covers different products. Hand-bent mesh, milled plates and 3D-printed implants are often grouped together, even though they may perform differently.6
- No good cost comparison. We found no head-to-head US cost study of PEEK versus titanium implants.
Questions to ask your surgeon
- Which material do you recommend for me, and why?
- How does the thickness and health of my scalp affect the choice?
- Will my implant be made specifically for me from my CT scan?
- What complications do you see most often with this material in your own patients?
- Will the implant affect future CT or MRI scans?
Related: cranioplasty infection rates.
Sources
- Liu L, et al. Comparison of complications in cranioplasty with various materials: a systematic review and meta-analysis. Br J Neurosurg. 2020;34(4):388-396. doi:10.1080/02688697.2020.1742291
- Henry J, et al. 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
- Zhu S, et al. Complications following titanium cranioplasty compared with nontitanium implants cranioplasty: a systematic review and meta-analysis. J Clin Neurosci. 2021;84:66-74. doi:10.1016/j.jocn.2020.12.009
- Oberoi MK, et al. Complications and failures of autologous heterotopic cranial bone versus alloplastic cranioplasties. Plast Reconstr Surg. 2024;154(4):757e-772e. doi:10.1097/PRS.0000000000011093
- Faedo F, et al. Infection rates following custom-made cranioplasty using heterologous materials: a systematic review on 3260 patients with a focus on follow-up length. Neurosurg Rev. 2025;48(1):657. doi:10.1007/s10143-025-03818-1
- Di Cosmo L, et al. Meta-analyses of the surgical outcomes using personalized 3D-printed titanium and PEEK vs. standard implants in cranial reconstruction. Neurosurg Rev. 2025;48(1):312. doi:10.1007/s10143-025-03470-9
- Samandar AF, et al. Complications of alloplastic graft materials used in cranioplasty: systematic review and network meta-analysis. Med Sci Monit. 2026;32:e950551. doi:10.12659/MSM.950551
- Pfnür A, et al. Exploring complications following cranioplasty after decompressive hemicraniectomy: a retrospective bicenter assessment of autologous, PMMA and CAD implants. Neurosurg Rev. 2024;47(1):72. doi:10.1007/s10143-024-02309-z
- Yoon HG, et al. Efficacy of 3D-printed titanium mesh-type patient-specific implant for cranioplasty. Korean J Neurotrauma. 2021;17(2):91-99. doi:10.13004/kjnt.2021.17.e25