Customized surgical guides

A method of manufacturing a surgical guide comprising:

• obtaining data to define the surgical guide for a patient including:
• a geometry of a bone surface of a first body area;
• a geometry of a main plate of a metal guide to be fitted to the bone surface, wherein the main plate includes a slot extending laterally along a width of the main plate for guiding a bone saw;
• a geometry of a body surface of a second body area, the first body area and the second body area are not contiguous;
• a geometry of a plastic reference to be fitted to the body surface including recesses in the plastic reference for fitting over teeth;
• and
• a geometry of a metal arm extending from the main plate to the plastic reference and a coupling between the metal arm and the plastic reference, the geometry of the metal arm partially based upon a relative position of the first body area with respect to the second body area;
• operating a first additive manufacturing system to print the metal guide which includes the metal arm rigidly integrated with the main plate;
• operating a second additive manufacturing system to print the plastic reference, the plastic reference having a reference surface with the recesses for fitting to and aligning over the teeth;
• and
• forming the coupling between the plastic reference and a distal end of the metal arm to provide a rigid and fixed location of the main plate relative to the reference surface and the recesses, such that the main plate and the plastic reference are held spaced apart by the metal arm, and a plane extending through the slot and along a longest dimension of the slot does not intersect the reference surface and the recesses when the metal arm and the plastic reference are coupled together.