This version of the game of Tetris uses a three-dimensional playing field as opposed to the traditional two dimensions more generally used. The player not only rotates the playing piece horizontally, but vertically as well which means that the piece has four possible directions in which to move.

3D Tetris includes three different ways to play: Center Fill, 3D Tetris, and Puzzle. In addition, each of the three allows players a choice of difficulty between easy, medium, and hard. Puzzle mode, in particular, broke with the traditional Tetris formula. It required players to build a certain shape using a diagram provided in the game.

The game included an option to save high scores with names, along with progress in the puzzle mode, to a battery backup.

A version was planned for Japanese markets. It was to be called Polygo Block, meaning literally Polygonal Block. It was to be released in February 1996. However, production of games was ceased due to lack of interest in the Virtual Boy system.