Since the 1950s, myriad materials have been used to reconstruct orbital floor fractures. Technological advances have afforded new materials for reconstruction. Recent comparisons of materials have not been reported. Retrospective chart review was performed using current procedural terminology coding for orbital floor fractures treated between 1991 and 2009. A total of 510 charts were reviewed; 317 adult patients met criteria. Forty-seven of these patients underwent bilateral floor explorations, yielding 364 orbital floor fractures. Mean age was 33.7 years. Motor vehicle collision, assault, all-terrain vehicles, and falls constituted the majority of injury mechanisms. Impure blowouts were the most common fracture type, and zygomaticomaxillary complex fractures were the most common pattern. Materials included autologous bone, porous polyethylene, titanium, and porous polyethylene with incorporated titanium. Use of bone graft correlated with postoperative orbital dystopia and enophthalmos, as compared with alloplastic implants. Bone rigidity, unpredictable thickness, and resorption may contribute. Once the gold standard of orbital reconstruction, autologous bone may have been eclipsed by modern materials.