STACKABLE SURGICAL GUIDES IN FULL-ARCH IMPLANT REHABILITATION: A SYSTEMATIC REVIEW

Aim of the study Stackable surgical guides have emerged as a key innovation in the digital workflow for full-arch implant rehabilitation, particularly in completely edentulous patients. These multi-level systems allow for precise and sequential execution of bone reduction, implant placement, and prosthetic delivery in a single surgical session. This systematic review aims to evaluate the current literature regarding the clinical application, workflow, and outcomes of stackable surgical guides in fully guided full-arch implant rehabilitation. Materials and methods Three distinct searches were conducted in the PubMed database. The first used the terms “stackable surgical guide” OR “stacked guide” OR “bone reduction guide,” which returned 197 results from the last 5 years, of which only 7 were relevant to dental implantology. Then we decided to extend the period and use a clearer term. So, a second search using only “stackable guide” over the last 10 years yielded 20 articles, with 13 included after screening. A third search using “facially driven treatment planning” identified 15 articles, with 2 meeting inclusion criteria. After merging and full-text review, 15 articles were included in this review. Results Stackable guide workflows consistently enabled guided osteotomy, implant placement, and provisional prosthesis installation. Common benefits included reduced chair time, improved accuracy, and predictable esthetic and functional outcomes. Limitations included cost, complexity, and limited long-term data. Conclusions Stackable surgical guides represent a promising advancement in fully guided full-arch implant rehabilitation. Prosthetically driven workflows—especially those starting from smile design and facial analysis—appear to offer greater clinical precision and patient satisfaction. More high-level clinical trials and long-term outcome data are needed to validate their widespread adoption.