Background: We describe two different techniques in re-construction of calvarial skull defects and to compare outcomes of using titanium mesh versus hand-made bone cement implant. Aim of Study: The aim of this study is to describe two dif-ferent types of technique in reconstruction of calvarial skull de-fects and to compare outcomes of using titanium mesh versus hand-made bone cement implant. Patients and Methods: The present study is a comparative study that was done for 30 patients who underwent cranioplasty in Cairo and Bani suef university hospitals, between January 2019 and December 2020. The patients were divided in two groups 15 in each, group A in which patients operated upon by cranioplasty with titanium mesh and group B in which patients operated upon by cranioplasty using handmade bone cement. In this study, The patient was then followed for three months in the outpatient clinic with the first visit 14 days from discharge, one month later then at the end of the three months to determine the cosmetic outcome and the patient satisfaction and also to make sure that no complications occurred “ wound dehiscence, exposure of implant, infection, overlying skin maceration or inflammatory signs, seizures, CSF leak, epidural or subdural haemorrhage. Results: As regards cosmetic outcome, there is statistically insignificant difference between both study groups and analysis of results showed that bone cement had slightly better cosmetic outcome. As regards duration of surgery, there is statistically significant difference between both study groups and analysis of results showed that bone cement cranioplasty had shorter operative period. As regards complication rate, there is statis-tically insignificant difference between both study groups and analysis of results showed that bone cement had higher rate of post-operative infection. Conclusion: When comparing both materials we found that the results were statistically significant as the duration of sur-gery (bone cement had shorter operative time). Other results showed statistically insignificant differences as cosmetic out-come (bone cement had slightly better cosmetic outcome) and post-operative complications (bone cement had higher rate of post-operative infection).