A stackable surgical guide is a multi-layer guide system where each layer is designed for a specific surgical phase. Unlike a standard single-piece guide, a stackable system separates the surgical workflow into discrete steps — typically extraction, osteotomy, and implant placement — with each step guided by its own template.

📖Surgical Guide

A 3D-printed template that fits over the patient's teeth or tissue and directs drill placement during implant surgery. It transfers the digital treatment plan into precise physical drill positions.

This approach is used for the most complex implant cases, particularly full-arch All-on-X rehabilitations where multiple procedures must be executed in precise sequence.

📖All-on-4

A full-arch implant rehabilitation protocol where 4-6 implants support a complete fixed prosthesis. It allows immediate loading, meaning patients receive teeth on the same day as surgery.

👉 Planning a complex case? Check our Surgical Guide Design Pricing or upload your CBCT for 24h delivery.

What Is a Stackable Guide?

A stackable guide consists of 2-3 individual guides that are designed to seat on top of each other or on the same anatomical reference points:

Layer 1: Extraction Guide

Marks the teeth to be extracted and their extraction vectors. This ensures that extraction sockets are preserved in the geometry needed for immediate implant placement.

Layer 2: Osteotomy Guide

Guides the pilot drill and sequential osteotomy drills to the planned implant positions. Sleeves are positioned at the exact angulations and depths calculated during digital planning.

Layer 3: Implant Placement Guide

The final layer seats on the prepared bone and directs the implant driver to the final depth and angulation. Some protocols combine layers 2 and 3 into a single guide.

When Is a Stackable Guide Necessary?

Full Arch Immediate Loading (All-on-4, All-on-6)

When the patient has remaining teeth that need extraction before implant placement, a stackable system coordinates both procedures in a single surgical session.

Alveolar Ridge Modification

Cases requiring bone reduction (alveoloplasty) before implant placement benefit from a separate reduction guide followed by an implant guide.

Staged Implant Protocols

When implants are placed in two phases (e.g., posterior implants first, anterior implants after healing), each phase gets its own guide layer.

Complex Prosthetic Requirements

When implant positions must coordinate with a pre-fabricated provisional prosthesis, a stackable system ensures that the prosthesis fits directly onto the implants placed through the guide.

The CAD Design Workflow

Step 1: Data Collection

  • CBCT scan with remaining dentition (pre-extraction)
  • Intraoral scan of the current teeth/denture
  • Wax-up or prosthetic design showing the desired final tooth positions

Step 2: Case Analysis

The designer evaluates:

  • Which teeth will be extracted
  • Available bone after extraction
  • Ideal implant positions relative to the prosthetic plan
  • Whether bone reduction is needed
  • Which surgical phases require individual guides

Step 3: Multi-Layer Design

Each guide layer is designed as a separate STL file, but all layers

📖STL File

A 3D surface mesh file format used in dental CAD/CAM. Intraoral scanners produce STL files that capture tooth and gingival surfaces for surgical guide fitting.