It stars Tobin Bell and Shawnee Smith, who reprise their roles from the previous films, alongside Synnøve Macody Lund, Steven Brand, Renata Vaca, and Michael Beach.

John later discovers that the operation is a scam, prompting him to kidnap those responsible and subject them to his trademark death traps as retribution, with Amanda Young (Smith) acting as his accomplice.

A tenth installment was reported to be in development with Twisted Pictures in April 2021, when Stolberg and Goldfinger, writers for the previous two entries of the series, announced that they had completed the script in December 2021.

On arrival in Mexico, John is driven to the clinic and introduced to Cecilia and her team — anesthesiologist Mateo, nurse Valentina, and Dr. Cortez — as well as patients Gabriela and Parker and the caretaker's young son Carlos, with whom he bonds.

He uncovers a video simulating his supposed brain surgery and removes his bandages to find no scar on his head, revealing the entire operation to be a scam.

Deducing that "Dr. Cortez" was his taxi driver Diego in disguise, John kidnaps and interrogates him, then forces him to play a "game" where he must remove pipe bombs lashed to his arms by cutting through his flesh, which he completes successfully.

Amanda restrains him while Mateo is forced to drill into his own skull and remove a piece of cerebral tissue to dissolve in a beaker and obtain a key.

A deadly chemical gas begins filling the room; the only respite is a ventilation hole large enough for one person's head, forcing Cecilia and Parker to fight each other.

[6] Josh Stolberg and Peter Goldfinger, writers for the previous two entries of the series, Jigsaw (2017) and Spiral (2021), confirmed the script was completed in December 2021.

That film's box office under-performance led Burg and Koules to go back to the franchise's roots for its tenth installment and make the story they had planned.

[9] Lionsgate and Media Capital Technologies, a specialty finance company, signed an muti-year deal to co-finance a slate of films, which included Saw X.

[8] In December 2022, Synnøve Macody Lund, Steven Brand and Michael Beach joined the cast,[13] along with Renata Vaca, Paulette Hernández, Joshua Okamoto, and Octavio Hinojosa.

However, they decided against it; Greutert expressed his support for this decision, saying that "some of the films that have de-aged their actors, it puts some distance between the character and the audience," feeling that Bell and Smith have some emotional close-ups that should not be altered.

[8] Steve Forner, the film's first assistant editor, had local police called on him during an editing session involving sound design of the custodian's trap.

While the parody was met with humorous responses by news outlets, it was pulled from Lionsgate's accounts due to a cease and desist order by AMC Theatres.

[4][3] In the United States and Canada, Saw X was released alongside The Creator, PAW Patrol: The Mighty Movie, and the wide expansion of Dumb Money, and was projected to gross $15–18 million from 3,262 theaters in its opening weekend.

The website's consensus reads: "Led by a franchise-best performance by Tobin Bell, Saw X reinvigorates the series with an installment that has a surprising amount of heart to go with all the gore.

She continues with: "The story mostly makes sense and Greutert pulls back on the frenetic editing techniques that made the older movies look like the blood and guts equivalent of white noise".

[46] Bob Strauss of the San Francisco Chronicle called the film "a well-told tale" and praised its character development and plot twists.

"[48] Helen O'Hara from Empire gave the film a score of two out of five, positively commenting on the blood and gore, calling it "all present and correct."

However, O'Hara criticized the film's main focus on Kramer's vulnerability and human side, adding that it "sits at odds with his awful judgmentalism.

"[49] Kyle Turner writing for Slant gave the film a score of two and half out of four, saying "The real disappointment is that Shawnee Smith, who makes a return to the series for the first time since Saw VI, is relegated to mostly doing John's dirty work.