Cranioplasty has been long practiced, and the reconstructive techniques continue to evolve. With a variety of options available for filling cranial defects, a review of the current practices in cranioplasty allows for reporting the most advanced techniques and specific indications.Overwhelming support remains for the use of autologous bone grafts in filling the cranial defects. Alloplastic alternatives have relative advantages and disadvantages depending on the patient population and specific indications. Application of imaging technology has allowed for the utilization of custom-made alloplastic implants when autologous bone grafts are not feasible.Autologous bone grafts remain the best option for adult and pediatric patients with viable donor sites and small-to-medium defects. Large defects in the adult population can be reconstructed with titanium mesh and polymethylmethacrylate overlay with or without the use of computer-assisted design and manufacturing customization. In pediatric patients, exchange cranioplasty offers a viable technique for using an autologous bone graft, while simultaneously filling the donor site with particulate bone graft. Advances in alloplastic materials and custom manufacturing of implants will have an important influence on cranioplasty techniques in the years to come.