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Featured Application: 3D-printed metal surgical guides offer several advantages (open-frame, stability) over traditional resin guides. This proof-of-concept study demonstrates the feasibility and the potential use of such guides during endodontic microsurgery procedures. Thanks to recent advances, printed surgical guides are now fully integrated into digital workflows and are beneficial in terms of accuracy in endodontic microsurgery (EMS). The aim of this study was to evaluate the accuracy of new 3D-printed surgical metal guides (SMGs) with open-frame structures in an endodontic surgical simulation model ex vivo based on a pig jaw. Twenty-nine roots were included. SMGs were produced using 3D implant planning software and printed using cobalt-chrome and a laser sintering printer. The SMGs were designed to allow for surgical access at 3 mm from the apex of each root. Virtual planning and postoperative CBCT scans were compared by analysing the apical and angular deviations. To test for deviations equal to zero, a one-sample test was used. The differences between the virtually planned implant and the actual position of the drill path were statistically significant for five SMGs on the eight produced guides, whereas there were no differences for the three others. The mean apical deviation was 3.2 mm ± 1.7 using SMGs, and the angular deviation was measured at 3.10 degrees ± 2.37. Although deviations were observed, the results demonstrate the feasibility and the potential for such guides during EMS procedures. [ABSTRACT FROM AUTHOR]