Successful diagnosis and satisfactory treatment require an accurate cast articulation that duplicates patient’s maxillomandibular relationship. Whereas few studies denote that occlusal precision might not be critical for treatment success, many researchers believe that accurate cast articulation is a necessity and the final dental prosthesis would not be acceptable if inaccuracy is introduced in any stage of dental cast mounting procedure. Achieving accurate cast articulation is a challenge for both clinician and laboratory technician. Literature has shown that errors are expected to happen in any step of the cast articulation process. Shortcomings associated with the materials used, inherent limitations of the articulators, restrictions of soft tissues such as the ligaments of the TMJ and masticatory muscles, are some issues that impact either directly or indirectly the accuracy of the cast articulation. However, many of cast articulation errors can be avoided through understanding the maxillomandibular relationship, appropriate selection of the materials and methods, and careful manipulation of the devices. Controlled studies on the clinical impact of cast articulation accuracy are needed to be conducted. Likewise, the quality of cast articulation could be improved by developing a new approach that eliminates several steps necessary with conventional procedures for mounting casts in an articulator.