Systems and methods provide patient-specific cutting blocks that allow for bone resurfacing procedures, such as milling or burring, with simplified devices. A computer assisted surgical cutting block is produced having a surface region that matches with the surface region of a patient's bone to be altered. A cutting tool may be provided having a contoured bone mating surface and a contoured and patient-specific shaped cutting guide surface, which is located in a plane above the bone mating surface. One or more channels are provided in the cutting block, and as the surgeon moves the cutting tool (a milling or burring, for example) in the channels the tool cuts the bone both laterally along the surface of the bone and vertically into the bone according to the cutting guide surface and other preselected surface features of the cutting block.