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There are several key differences in gameplay from the original Tetris. First, in addition to clearing lines, one can also form 4x4 large squares of four pieces to form blocks. When a block is created, it turns solid gold or silver, depending on the makeup of the block. Blocks can only be constructed from whole pieces: if any part of a piece has been cleared, then it cannot be used to form a block. When a line that has pieces from a block is cleared, it earns more points.

Tetrisphere is a variant on Tetris in which various shapes are shifted across a wrapped three-dimensional grid resembling a sphere, and then destroyed. The objective of the game changes depending on the mode, but generally consists of removing layers of shapes to reach the playing field's core. Despite very little domestic advertising, Tetrisphere enjoyed moderately good sales and a mostly favorable critical reception. Reviewers praised the game's originality and the musical score composed by Neil D. Voss.