Evaluation of Cast Re-Orientation on a Dental Surveyor Using

Three Tripod Techniques: A Survey and In Vitro Study

Mohammed E. Sayed, BDS, MDS, FRCDC, FACP, PhD(C),1,2 Idris A. Busaily, BDS,2 Rana J. Nahari, BDS,2
Ruaa O. Hakami, BDS,2 Sami M. Maashi, BDS,2 & Naveen R. Ramireddy, BDS, MDS2
1
Department of Restorative Dentistry, Rutgers School of Dental Medicine, Newark, NJ
2
Department of Prosthetic Dental Sciences, Jazan University College of Dentistry, Jazan, Saudi Arabia

Keywords
Cast tripod; education levels; reorientation
accuracy; cast survey; RPD diagnosis; RPD
treatment planning.
Correspondence
Mohammed E. Sayed, Department of
Restorative Dentistry, Rutgers School of
Dental Medicine, 110 Bergen St., Room
D-830, Newark, NJ 07101.
E-mail: drsayed203@gmail.com
The authors deny any conflicts of interest.
Accepted November 17, 2016
doi: 10.1111/jopr.12581
Abstract
Purpose: To survey different educational levels (i.e., students, interns, technicians,
and prosthodontic faculty) with regard to their opinions, attitudes, and adoption of
three selected tripod techniques. The study will also investigate the accuracy of these
techniques to reposition casts on the dental surveyor in anterio-posterior (AP) and
lateral directions at both technique and educational levels.
Materials and Methods: Tripod points, scored lines, and cemented post tripod
techniques were used in this study. Three Kennedy class II modification I stone casts,
duplicated from a standard cast, were assigned to each of the tripod techniques.
The tilt angles of all casts were set on the dental surveyor to 10° (control angle)
in AP and lateral directions using a digital angle gauge with an accuracy of 0.2°.
The casts were tripoded accordingly. A total of 243 participants were involved in
this study. Participants were first asked to remount the three casts on three different
dental surveyors using the tripod technique noted on each cast. Questionnaires were
then given to each participant in an individual interview setting; this assured a 100%
response rate. The angle differences were calculated. All data were coded and entered
into an Excel Spreadsheet file. Statistical analyses were performed using a paired
Chi-square, Wilcoxon Matched-pairs, ANOVA, and Tukey post hoc tests at 5% level
of significance.
Results: No significant difference was found between the educational levels relative
to the responses to technique demands, sensitivity, and time required for reorientation
(p = 0.08202, 0.8108, 0.6874, respectively); however, the majority of respondents
reported low technique demands, low sensitivity, and time saving for technique C
in comparison to techniques A and B. Significant differences were noted among the
educational levels in response to preference and adoption questions (p = 0.0035
and 0.0015, respectively). The highest percentage of faculty chose technique A for
inclusion into the academic curriculum. Wilcoxon Matched-pairs test revealed that
technique C was the least difficult and most practical (p = 0.0001, 0.0427, respec-
tively). One-way ANOVA revealed significance in angle differences from the set
position for technique A in lateral tilt and techniques A and B in AP tilt (p = 0.0466,
0.0194, 0.0424, respectively). A comparison of positivity (overtilt) and negativity
(undertilt) between the three techniques in lateral and AP tilts using Chi-square test
resulted in significant differences in both directions of tilt (p < 0.0001). Technique C
resulted in remounting the casts at the control position in 15.64% in both directions;
this was a higher percentage than the other two techniques (A and B). Wilcoxon
Matched-pairs test was used to compare between the techniques relative to angle
differences from the standard position. No differences were found between technique
A and B in lateral tilt position (p = 0.9271), while significance was detected in AP tilt
(p < 0.0001). Significant differences were detected between technique C in compari-
son to A (p < 0.0001, p = 0.0303) and B (p < 0.0001) in lateral and AP tilt directions.
Conclusions: Within the limitations of this study, it can be concluded that technique
C (cemented post technique) was more favored among the respondents across all
educational levels. This technique presented high potential in accurately reorienting
casts on the dental surveyor in comparison to the tripod points and scoring techniques
(p < 0.0001).

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Sayed et al
For successful treatment planning for removable partial den-
tures (RPDs), clinicians must adequately understand the biome-
chanical inter-relationship between prostheses and surrounding
tissues.1 Careful analysis of the diagnostic cast, at the start of
the planning phase for RPD treatment, is undeniably a funda-
mental step for proper treatment.2-4 The first step in diagnostic
cast analysis is the selection of a tentative path of insertion in
anterio-posterior (AP) tilt and desired undercuts in lateral tilt
followed by the cast survey. These steps allow dental clinicians
to study and design appropriate RPD frameworks.5 The se-
lected path of insertion and lateral tilt must be recorded on the
diagnostic cast and be accurately transferred onto the master
cast to permit dental technicians to reposition the casts on the
dental surveyor accurately.6 Recording the cast spatial position
or cast tripod as a step in the process of RPD construction can be
defined as “the marks or lines drawn on a cast in a single plane,
perpendicular to the survey rod, to accurately reposition the cast
on a dental surveyor in a previously defined orientation.”7 The
main function of this laboratory step is to record and maintain
the dimensional position of the casts relative to the selected
path of insertion and lateral tilt for future reference.8,9
Several cast reorientation techniques have been proposed in
the dental literature. These techniques include: widely sepa-
rated tripod points on the cast anatomic areas, vertical lines or
grooves on the side or the land areas of the cast,8,9 a pin ce-
mented in the center of the tongue area of the cast,2 protractor
to record angles at preselected points,10 modified dental bur
(instead of pin cemented in the center of tongue area of the
cast),11 positioning device on a surveyor,12 and the use of a
universal U-shaped tray13 and acrylic resin index.14
From an academic standpoint, teaching and practicing the
standard RPD concepts and designs throughout the steps of
RPD fabrication should be initiated and reinforced at the un-
dergraduate level. Several studies have reported a similarity in
RPD teaching curriculum among dental schools globally.15-17
However, one study has indicated that 18% of U.S. dental
schools permit students to graduate without a predetermined
set number of RPD clinical requirements,17 potentially lead-
ing to insufficient knowledge and experience in planning even
for simple RPD clinical cases following graduation. A survey
among experienced prosthodontists and postgraduate residents
was conducted to evaluate the concepts used during RPD de-
sign and fabrication. This survey revealed that the majority of
participants always followed the standard clinical and labora-
tory guidelines, with 92% providing a survey and tripod of
the RPD master cast prior to communicating with the dental
laboratory.18 The difference in educational levels between clin-
icians may affect their knowledge and clinical experience in
performing the standard steps for such treatment modality.19
The scope of this study was to focus on cast tripoding as one
of the most fundamental steps in RPD fabrication. The current
literature lacks a direct comparison between available tech-
niques at various educational levels. Therefore, the aim of this
study was to survey different educational levels (i.e., students,
interns, technicians, and prosthodontic faculty) with regard to
their opinions, attitudes, and adoption of the three selected tri-
pod techniques. This study will also investigate the accuracy of
these techniques to reposition casts on the dental surveyor in
the AP and lateral directions at both technique and educational
Journal of Prosthodontics 27 (2018) 700–707 
C 2017 by the American College of Prosthodontists
Evaluation of Three Cast Reorientation Techniques
levels. The null hypotheses stated that there would be no differ-
ences in the opinions, attitudes, and adoption of the three tripod
techniques across educational levels and no differences in the
accuracy within and between these tripod techniques when used
to remount the casts on the dental surveyor.
Materials and methods
Specimen preparation
A standard Kennedy class II modification I cast was dupli-
cated in duplicating silicone (Dupliflex-22; Protechno, Vila-
malla, Girona, Spain), and three stone casts were poured in
type III laboratory stone (Lab Stone; Dentsply, York, PA) fol-
lowing the manufacturer’s instructions and using a vacuum
mixer (Mix-R; Dentalfarm, Torino, Italy) and a laboratory vi-
brator (MiniExport; Dentalfarm). Since the stone casts were
identical, an occlusal mounting index was made of one cast.
To fabricate the mounting index, a maxillary perforated metal
stock tray (GC Corp, Tokyo, Japan) was modified by removing
the palatal portion and reduction of buccal flange length to 3
mm long. A tray adhesive agent (VPS Tray Adhesive; Henry
Schein, Melville, NY) was applied on the intaglio surface of
the tray. An occlusal registration material (Blu-Bite HP; Henry
Schein, Melville, NY) was injected into the metal tray, adapted
on the stone cast, and allowed to set per manufacturer’s instruc-
tions. The excess registration material beyond the borders of the
metal tray and the intaglio surface (except for cusp tips, incisal
edges, and crest of the distal extension ridge), were trimmed
with a scalpel blade #15 (Swann-Morton, Sheffield, UK) to
eliminate interferences upon multiple index placement on the
casts. A light-cured acrylic resin sheet (Meditray; Promedica
Dental Material GmbH, Neumunster, Germany) was adapted
on top of the metal tray and cured in a laboratory light-curing
unit (Trubyte Triad 2000; Dentsply) for 7 minutes. The pur-
pose of this step was to provide a horizontal table to properly
adapt the study measurement tool. The tray adhesive and oc-
clusal registration materials were applied on the acrylic resin
surface, and a digital angle gauge (AccuRemote, San Clemente,
CA) was adapted and stabilized until the registration material
was completely set. This step was performed twice to provide
a positive seat for the device upon the measurement of AP
and lateral tilt angles. The purpose of the digital angle gauge
in this study was to help in accurate setting of the path of
insertion, lateral tilt, and measurement of the angle changes
throughout the study with an accuracy of 0.2° and repeatability
of 0.1°.
Each of the three stone casts was assigned to represent one
tripod technique and mounted on a dental surveyor (A3005
Surveyor Type A; Dentalfarm). The AP and lateral tilts were set
to a control angle of 10° for all the stone casts using the digital
angle gauge (Fig 1). For technique A, three widely separated
tissue points were marked with a graphite pencil, in the same
horizontal plane, on the lingual aspect of the stone cast utilizing
a mounted analyzing rod on the vertical arm of the surveyor. The
points were placed at the central incisors, and the approximate
locations of the right and left first molars and were identified
with circled cross markings (Fig 2A). In technique B, four score
lines were made with a graphite pencil parallel to the side of
701
Evaluation of Three Cast Reorientation Techniques Sayed et al

Figure 1 Setting the path of insertion (A) and

lateral tilt (B) to a control angle of 10° in both
directions.

Figure 2 Study groups (A) Technique A: Tissue Points; (B) Technique B: Scored Lines; and (C) Technique C: Cemented Post (Acrylic Bur).

the analyzing rod on the side borders of the cast. The lines were
placed at the central incisors and the posterior aspect of the stone
cast (Fig 2B). For technique C, cemented post (acrylic bur), a
hole 5 mm wide and 10 mm deep was prepared with a straight
acrylic bur (Brasseler, Savannah, GA) in the center of the lingual
area near the posterior aspect of the stone cast allowing adequate
space for the mounting index and measuring device during data
collection. The same acrylic bur was mounted on the vertical
arm of the surveyor with the working end facing the hole in the
stone cast. The working end of the acrylic bur was inserted until
it touched the base of the hole. An orthodontic resin (Dentsply
Caulk, York, PA) was used to cement the bur inside the hole and
allowed to set overnight while the cast was still mounted on the
surveyor (Fig 2C). All three tripod techniques were performed
at the control angle with the surveying table passively adapted
on the surveyor horizontal shelf. Due to the extreme sensitivity
of the digital angle gauge, the surveyors were maintained in the
same position through the entire time of the study. Following
the tripod step, all stone casts were removed from the survey
tables.

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Sayed et al
Experiment and survey
A standard questionnaire was prepared for this study. The ques-
tionnaire was pretested and validated prior to initiating the study
through a pilot study. Cronbach’s alpha value of 0.91 showed a
good internal consistency of the study tool. The questionnaire
was designed to include questions on technique demands re-
lated to the laboratory steps and armamentaria, sensitivity, time
required to remount the casts on the surveyors, preference,
adoption of the techniques, and inclusion into the academic
curriculum. Technique difficulty and practicality on a scale of
0 to 5 were included as parts of the survey questionnaire. An
angle recording table was added to the end of each question-
naire document to be used by the examiners. A total of 243
participants (158 students, 50 interns, 15 technicians, 20
prosthodontic faculty) were included in this study. Ethical ap-
provals were obtained from the Institutional Review Board
(IRB) at Jazan University College of Dentistry prior to initi-
ating the study. Four examiners were trained and calibrated,
and a pilot study was conducted to evaluate the intra- and inter-
examiner measurement variability. Inter- and intra-examiner
reliability and reproducibility were evaluated using ICC and
ICCR tests on SPSS 20 statistics software (SPSS Inc, Chicago,
IL). The intra- and interclass correlation coefficient values were
0.971 and 0.983, respectively. The study was conducted over
the period of September 1, 2015 to March 31, 2016. Partici-
pants were recruited and called-in individually, and each was
given a brief description of the study and instructed to remount
the casts on each surveyor using the tripod marking assigned
for each technique. The participants were asked to tighten the
fixation knob of the survey table at the end of the remount
step. Each participant was given a copy of the questionnaire to
complete and asked to leave the study area at the completion
of participation. The digital angle gauge was mounted on each
stone cast to measure and document the tilt angles in the AP
and lateral directions as performed by each participant per each
technique.
Data analysis
The questionnaire, reorientation angles, and angle differences
data were coded and entered into a Microsoft Excel Spreadsheet
(Microsoft Inc, Redmond, WA). The questionnaire documents
were stored in the assigned area provided by the college. The
differences between the control angle and the remount angles
by participants were calculated in the AP and lateral tilts. Sta-
tistical analyses of the participants’ response to the questions
on technique demands, sensitivity, time consumption, prefer-
ence, adoption, and inclusion into the academic curriculum
were performed using Chi-square test. Wilcoxon Matched-pairs
test was performed to analyze the scaled response (0 to 5) rela-
tive to difficulty and practicality questions. One-way ANOVA
was used for analyses of the angle differences within each
technique in AP and lateral directions across education levels.
Tukey’s multiple post hoc tests compared the mean angle dif-
ferences between the educational levels. Chi-square test com-
pared between the three techniques relative to the positivity and
negativity in lateral and AP directions. Finally, a comparison
between the three techniques relative to the angle differences
in lateral and AP directions was performed using Wilcoxon
Journal of Prosthodontics 27 (2018) 700–707 
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Evaluation of Three Cast Reorientation Techniques
Matched-pairs test. For all analyses, a p-value < 0.05 was re-
garded as statistically significant. Data were analyzed using
SPSS 20 Statistics Software, and α was set at 5% level of
significance.
Results
No significant difference was found between the educational
levels of the respondents with regard to their responses to
technique demands, sensitivity, and time required to remount
the casts on the dental surveyor relative to each technique
(p = 0.08202, 0.8108, 0.6874, respectively); however the high-
est percentage of students (43.67%) reported higher technique
demands for technique A, followed by technique B (31.01%),
and technique C (25.32%); a high percentage of interns (50%)
reported high technique demands for technique B followed by
technique A (38%) and technique C (12%). On the contrary,
a high percentage of technicians and faculty (53.33%, 45%,
respectively) reported high technique demands for technique A
followed by C (26.67%, 35%, respectively) and technique B
(20% for both). All education levels reported higher technique
sensitivity for technique A (44.3%, 46%, 60%, 55%, respec-
tively), followed by technique B (38.61%, 42%, 33.33%, 25%,
respectively), and technique C (17.09%, 12%, 6.67%, 20%,
respectively). The time required to remount the casts on the
surveyors, showed less time for technique C across all educa-
tional levels (84.81%, 80%, 80%, 80%, respectively) and sub-
tle differences between technique A (8.23%, 6%, 6.67%, 10%,
respectively) and technique B (6.96%, 14%, 13.33%, 10%, re-
spectively) (Fig 3).
A significant difference was found between all the educa-
tional levels with regard to the preference and adoption of each
technique (p = 0.0035 and 0.0015, respectively). A higher per-
centage of students (79.74%) preferred technique C, followed
by technique A (12.65%) and technique B (7.59%). The same
technique preference pattern was found for interns (68%, 30%,
2%, respectively), technicians (46.66%, 33.33%, 20%, respec-
tively), and faculty (55%, 35%, 10%, respectively). Regarding
adoption of a specific technique in day-to-day practice, higher
percentages of students, interns, and technicians were for tech-
nique C, followed by technique A and B. A higher percent-
age of faculty chose technique A (50%), followed by tech-
nique C (35%) and technique B (15%). Faculty also favored
technique A (55%) for inclusion into the academic curricu-
lum, followed by technique C (30%) and technique B (15%)
(Fig 4).
A scale of 0 to 5 was used to report the difficulty of each tech-
nique across the educational levels. Score 1 means the easiest,
while score 5 means the most difficult. A significant difference
was found between the reported scores in technique C only
(p < 0.0001). High percentages of the students (34.18%), in-
terns (38%) and faculty (40%) gave a score of 3 for technique
A, while the most common score for technicians (46.67%) was
4. For technique B, the most common score was 3 for students
(31.65%), interns (38%), and faculty (35%), while technicians’
most common score was 2 (46.67%). Among students, interns,
and faculty, the most commonly reported score was 1 for tech-
nique C (61.39%, 62%, 40%, respectively). The technicians
most commonly reported score was 2 (Table 1).
703
Evaluation of Three Cast Reorientation Techniques Sayed et al

A B C
100

90

80

70
Percent

60
Students
50 Interns
40 Technicians
30 Faculty
20

10

0
Demands Demands Demands Sensivity Sensivity Sensivity Time Time Time
TA TB TC TA TB TC Saving TA Saving TB Saving TC

Figure 3 Composite bar chart shows the percentages of participants’ responses to (A) technique demands, (B) technique sensitivity and (C) time
required to remount the cast on the surveyor questions across all educational levels. Coding TA-TC refers to techniques A-C. No significant differences
were found between the educational levels with regard to their responses to these parameters relative to each technique (P-value = 0.08202, 0.8108,
0.6874, respectively).

A B C

100

90

80

70
Percent

60
Stuents
50 Interns
40 Technicians
30 Faculty
20

10

0
Preference Preference Preference Adopon Adopon Adopon Teaching Teaching Teaching
TA TB TC TA TB TC TA TB TC

Figure 4 Composite bar chart shows the percentages of participants’ responses to (A) technique preference, (B) adoption and (C) inclusion into the
academic curriculum questions across all educational levels. Coding TA-TC refers to techniques A-C. Significant differences were found between the
educational levels with regard to preference and adoption relative to each technique (P-value = 0.0035 and 0.0015, respectively). Faculty responses
to technique inclusion into the academic curriculum (teaching) indicated high percentage for technique A followed by C and B.

A similar scoring method was used to report the practical-
ity of each technique across the educational levels. In this in-
stance score 1 means the least practical, while score 5 means
the most practical. Significant differences were found between
the reported scores for technique C (p < 0.0427). Low practi-
cality scores were reported by the majority of the educational
levels for technique A. A similar response is noted for tech-
nique B, but the faculty (35%) gave a score 4. The major-
ity of the educational levels reported the highest practicality
score (5) for technique C (63.3%, 64%, 70%, respectively),
except for the technicians who gave it a score of 4 (46.67%)
(Table 2).

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Sayed et al Evaluation of Three Cast Reorientation Techniques

Table 1 Percentages of participants’ reported scores across techniques and educational levels relative to technique difficulty (score 1 means the
easiest, while score 5 means the most difficult)

All (n = 243)

Students Interns Technicians Faculty

Techniques Scores (n = 158) (n = 50) (n = 15) (n = 20) Chi-square P-value

Technique A 1 14 (8.86%) 3 (6%) 2 (13.33%) 6 (30%) 17.6981 0.1252

2 25 (15.82%) 9 (18%) 2 (13.33%) 1 (5%)
3 54 (34.18%) 19 (38%) 2 (13.33%) 8 (40%)
4 43 (27.22%) 14 (28%) 7 (46.67%) 2 (10%)
5 22 (13.92%) 5 (10%) 2 (13.33%) 3 (15%)
Technique B 1 19 (12.03%) 5 (10%) 0 (0%) 2 (10%) 11.3509 0.4991
2 36 (22.78%) 13 (26%) 7 (46.67%) 4 (20%)
3 50 (31.65%) 19 (38%) 3 (20%) 7 (35%)
4 30 (18.99%) 5 (10%) 3 (20%) 6 (30%)
5 23 (14.56%) 8 (16%) 2 (13.33%) 1 (5%)
Technique C 1 97 (61.39%) 31 (62%) 5 (33.33%) 8 (40%) 50.0316 <0.0001∗
2 47 (29.75%) 11 (22%) 9 (60%) 5 (25%)
3 6 (3.80%) 8 (16%) 1 (6.67%) 1 (5%)
4 6 (3.80%) 0 (0%) 0 (0%) 2 (10%)
5 2 (1.27%) 0 (0%) 0 (0%) 4 (20%)

Table 2 Percentages of participants’ reported scores across techniques and educational levels relative to technique practicality (score 1 means the
least practical, while score 5 means the most practical)

All (n = 243)

Students Interns Technicians Faculty

Techniques Scores (n = 158) (n = 50) (n = 15) (n = 20) Chi-square P-value

Technique A 1 25 (15.82%) 4 (8%) 2 (13.33%) 6 (30%) 11.8983 0.4539

2 49 (31.01%) 10 (20%) 5 (33.33%) 4 (20%)
3 47 (29.75%) 23 (46%) 5 (33.33%) 4 (20%)
4 22 (13.92%) 8 (16%) 2 (13.33%) 3 (15%)
5 15 (9.49%) 5 (10%) 1 (6.67%) 3 (15%)
Technique B 1 23 (14.56%) 10 (20%) 3 (20%) 1 (5%) 17.1819 0.1430
2 53 (33.54%) 13 (26%) 3 (20%) 3 (15%)
3 49 (31.01%) 15 (30%) 5 (33.33%) 5 (25%)
4 24 (15.19%) 7 (14%) 4 (26.67%) 7 (35%)
5 9 (5.70%) 5 (10%) 0 (0%) 4 (20%)
Technique C 1 11 (6.96%) 0 (0%) 0 (0%) 1 (5%) 21.5710 0.0427∗
2 10 (6.33%) 3 (6%) 0 (0%) 1 (5%)
3 9 (5.70%) 6 (12%) 3 (20%) 2 (10%)
4 28 (17.72%) 9 (18%) 7 (46.67%) 2 (10%)
5 100 (63.3%) 32 (64%) 5 (33.33%) 14 (70%)

Table 3 reports the means (SD) of angle differences, from 10°,
within each technique in lateral (L) and anterior-posterior (AP)
tilts across the educational levels. One-way ANOVA showed
significant angle differences between the educational levels for
technique A in lateral and techniques A and B in AP tilts.
Positive values mean overtilt, while negative means under-
tilt relative to the control angle in both directions. Further-
more, pairwise comparison of educational levels with respect
to the means of angle differences using Tukey’s Multiple post
hoc tests, significance was found between students and interns
(p = 0.0403), students and technicians (p = 0.0260), students
and faculty (p = 0.0144), interns and faculty (p = 0.0135).
Comparisons of positivity and negativity of tilt between the
three techniques revealed statistical significance in lateral and
AP tilts (p < 0.0001) (Table 4). In lateral tilt, only 15.64%
of the participants using technique C, were able to reposition
the casts on the surveyor at the control angle in comparison to
technique A (2.88%) and technique B (2.47%). Technique C
resulted in a positive tilt (47.74%), whereas techniques A and
B (73.25% for both), resulted in a negative tilt relative to the

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Evaluation of Three Cast Reorientation Techniques Sayed et al

Table 3 Means (SD) of angle differences within each technique in lateral (L) and anterior-posterior (AP) tilts across educational levels (Negative values
mean undertilt, while positive means overtilt relative to the control angle (10°) in both directions)

All (n = 243)

Students Interns Technicians Faculty

Variables (n = 158) (n = 50) (n = 15) (n = 20) F-value P-value

Tech A L Diff –2.08 (3.65) –1.65 (3.13) 0.49 (2.97) –2.05 (1.93) 2.6957 0.0466∗
Tech A AP Diff –0.55 (4.20) –0.87 (2.36) –0.29 (2.54) 2.08 (2.34) 3.3653 0.0194∗
Tech B L Diff –2.11 (4.16) –1.90 (3.03) –2.65 (3.09) –2.21 (2.85) 0.1558 0.9259
Tech B AP Diff –3.53 (4.46) –1.70 (4.31) –3.18 (3.29) –4.22 (2.87) 2.7684 0.0424∗
Tech C L Diff 0.23 (1.10) –0.02 (0.88) 0.24 (0.57) 0.52 (0.71) 1.4831 0.2198
Tech C AP Diff –0.20 (0.92) –0.20 (0.90) –0.14 (0.54) –0.33 (0.83) 0.1449 0.9329

Table 4 Comparison of positivity (overtilt) and negativity (undertilt) between the three techniques in lateral (L) and anterior-posterior (AP) tilts

Tilt Angle difference Technique A Technique B Technique C Chi-square P-value

L Zero 7 (2.88%) 6 (2.47%) 38 (15.64%) 102.9270 <0.0001∗

Positive 58 (23.87%) 59 (24.28%) 116 (47.74%)
Negative 178 (73.25%) 178 (73.25%) 89 (36.63%)
AP Zero 8 (3.29%) 5 (2.06%) 38 (15.64%) 82.2094 <0.0001∗
Positive 109 (44.86%) 48 (19.75%) 82 (33.74%)
Negative 126 (51.85%) 190 (78.19%) 123 (50.62%)

lateral control angle. In AP tilt, 15.64% of the participants using
technique C were able to reposition the casts on the surveyor
at the control angle in comparison to technique A (3.29%) and
technique B (2.06%). Technique A resulted in a positive tilt
(44.86%), whereas technique B (78.19%) resulted in a negative
tilt relative to the AP control angle.
Wilcoxon Matched-pairs test to compare between three tech-
niques with regard to angle differences in lateral and AP tilts,
revealed significant differences between techniques A and C,
and between techniques B and C, without any detectable signif-
icance between A and B in lateral tilt. Moreover, statistical sig-
nificance was found between all three pairs in AP tilt (Table 5).
Discussion
Although RPDs are considered the treatment of choice in many
clinical instances, they might not be successful in meeting
the functional or esthetic demands of some patients due to
production-related problems as one of many potential causative
factors. The proper integration of dental surveyors in diagnosis
and treatment planning of RPDs is undeniably a fundamental
key for treatment success, as it allows clinicians to plan, study,
and design proper RPDs that satisfy all biomechanical and es-
thetic requirements.20 The step of stone cast tripod subsequent
to selection of the lateral and AP tilts is crucial to maintain the
same spatial position of the stone cast, to include the diagnostic,
master, and duplicate casts, on the dental surveyor throughout
the treatment steps of the partial denture construction.2-14
Careful literature review revealed that this was the first study to
survey and experimentally compare three conventional tripod
techniques across all educational levels. The results of the
present study supported rejection of the null hypotheses.
The results of the survey part of this study favored technique
C in all educational levels across the survey parameters;
however, no significant differences were found between the
educational levels within each technique, except for their
responses to preference and adoption questions. The majority
of the participants reported higher preference and adoption
rates for technique C, followed by techniques A and B, except
for faculty where the majority reported higher adoption rate and
willingness to teach technique A. Although this finding was
not supported in the literature, it might explain why technique
A is familiar and mostly used for academic teaching in dental
schools worldwide. Additionally, consistent responses from all
educational levels disclosed technique C as the least difficult
and most practical of the studied techniques.
The time needed to reorient the casts on the dental surveyor
in this study was consistent with the study done by Wagner and
Forgue.4 Although their study involved one participant only,
a technician, both studies showed less time required for cast
reorientation in comparison to the other techniques. In addi-
tion, both studies reported that technique C presented the least
deviation angle from the set position. There was no significant
difference in the lateral tilt angles for technique B. This might
be explained by better visibility and control upon paralleling
the sides of the analyzing rod to the lines made at the front and
sides of the cast when compared to AP tilt.
The final position subsequent to cast reorientation is cru-
cial, as changes in AP and lateral tilt may result in changes
in the path of insertion and quality/quantity of the undercuts,

706 Journal of Prosthodontics 27 (2018) 700–707 

C 2017 by the American College of Prosthodontists
Sayed et al
Table 5 Comparison between the three techniques with regard to angle differences in lateral (L) and anterior-posterior (AP) tilts
L AP
Techniques T-value Z-value
Tech A vs. Tech B 1936.0000 0.0915
Tech A vs. Tech C 1685.5000 7.3269
Tech B vs. Tech C 2286.0000 7.0770
respectively. In the lateral tilt, the majority of participants in
technique C (47.74%) reoriented the cast in an overtilt position.
Hence differences were positive compared to the set angle. This
might result in exaggerated undercuts and binding clasp arms
upon RPD delivery. A possible explanation of this finding was
that the survey table might not have been passively adapted on
the surveyor’s horizontal shelf upon reorientation. Techniques
A and B (73.25% for both) showed higher chances of undertilt;
hence, differences were negative, which might cause loss of the
undercuts and therefore the retentive ability of the clasp assem-
bly. In AP tilt, a higher percentage of participants reoriented the
casts in positive and negative positions relative to the set posi-
tion, in techniques A and B, respectively. This finding indicates
that the use of such techniques may result in changing the path
of insertion from the planned position, which may subsequently
affect the treatment outcomes. The results of this study were in
agreement with a similar study,21 except the authors compared
the first two techniques to a positioning device mounted on the
surveyor. Perhaps such findings indicate the need for inclusion
of technique C into the academic curriculum and increasing
its adoption among providers of the partial denture treatment
modality.
This study was limited to three techniques. Further research is
needed to investigate the differences between the other available
techniques involving the residents in postgraduate prosthodon-
tic programs as a valuable study group.
Conclusions
Within the limitations of this study, it can be concluded that
1. Technique C (cemented post technique) was favored
among the respondents across all educational levels.
2. Technique C presented high potential in accurately re-
orienting casts on the dental surveyor in comparison to
tripod points and scoring techniques (p < 0.0001).
Acknowledgments
The authors would like to extend gratitude and appreciation to
Jazan University College of Dentistry for giving permissions
and providing the required materials to conduct this study.
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Journal of Prosthodontics 27 (2018) 700–707 
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