The aim of this study was to assess three-dimensional distortion in cast full-arch, screw-retained titanium implant frameworks. A conventional commercial laboratory one-piece casting was used implementing the lost-wax technique. Five wax patterns were fabricated on a die-stone cast poured from a plaster impression of a five-implant brass analog. A reflex microscope was used to determine the three-dimensional casting error. Significant differences were found in distortion between wax patterns and castings, which, given the need to keep within 150 µm of misfit for passivity, were larger than the wax frameworks by between 416 and 477 µm. The greatest distortion occurred at the terminal implant abutments and in the vertical dimensions, but the distortion was inconsistent, indicating its three-dimensional nature. It is doubtful whether any conventionally cast titanium framework can be made to the degree of accuracy required to fit passively on its abutments because of the multiple variables inherent in this process.