The three-dimensional guidance system for implant insertion is a technique for placing a radiopaque vertical orientation pin over the crest of the alveolar ridge on the stone cast during fabrication of the radiographic guide. The cross-sectional and panoramic reformatted images were reproduced on a Polaroid or 35-mm print. The true vertical orientation pin facilitates (1) identification and the exact planned location of each implant in the reformatted images of the CT scan, (2) establishment of the internal starting point for the osteotomy on a photographic print, (3) optimum implant orientation, and (4) measurement of the angulation between the true vertical orientation line and optimum implant orientation. With the aid of a newly developed dual-axes base and transfer of the internal starting point of each implant to the stone cast, the buccolingual and mesiodistal implant inclinations for each implant were transferred to a surgical guide in the form of surgical steel drill guide tubes. The resulting pilot osteotomy transfers to the alveolar bone the exact starting point and the buccolingual and mesiodistal inclination for each implant. The technique provides a three-dimensional guidance system for implant insertion that is extremely accurate and yet practical.