Bone reduction with stackable surgical guides: an evolving digital workflow

Bone reduction is a critical step in complete arch implant rehabilitation, ensuring adequate restorative space and prosthetically guided implant positioning. This paper presents a complete digital workflow for guided bone reduction using stackable surgical guides, designed to integrate the prosthetic plan with surgical execution. A prosthetically driven approach was implemented by merging CBCT data, intraoral scans, and virtual wax-ups within CAD planning software. A multi-layer stackable guide system was digitally designed and 3D printed to sequentially guide bone reduction, implant placement, and immediate loading. The workflow is illustrated through one representative clinical case involving mandibular terminal dentition and maxillary complete edentulism. The digital workflow enabled accurate and reproducible transfer of the virtual plan to the clinical field, optimizing the vertical restorative dimension and alignment of implants within the prosthetic envelope. The stackable guide system ensured stable positioning, reduced variability during the surgical procedure, and enhanced coordination between clinician and technician. The stackable surgical guide workflow allows for reliable , safe, and reproducible bone reduction procedures, aligning every surgical phase with the final prosthetic design. This approach minimizes complications and improves predictability in complete arch implant rehabilitations.