First off a brief overview of each method will probably better assist in understanding why there seems to be such strong opinion regarding which method ‘is best’. Having personally and clinically used database/antagonist for years now, notably successfully on a wide range of clinical cases (as well as a professionally created and internationally/widely distributed DVD entitled Database/Antagonist: The Complete Reference) its fair to say I understand a few of the benefits, and shortcomings of using that method extensively in a real world environment. 

This fact cannot, and does not overlook the fact that I have also used correlation for an even longer period (and having created 2 separate DVD’s distributed internationally on that method as well) of time and many thousands of real world cases as well. 

Most people have ‘designated’ me as the (unwittingly sometimes) apparent ’spokesperson’ for the ‘database/antagonist’ method simply because they know I have worked, developed and taught a growing number of CEREC users on that method over the years. While I am certainly biased towards that method with the new 3D system it is because it more accurately and easily generates restorations, especially multiple units, or quadrants than any previous version (read correlation based) 

That is NOT to say I dont use correlation anymore…far from it, I still use and even recently developed a whole new set of clinical routines to use -correlation- for completion of anterior reconstruction cases, finding that method FAR easier to accurately use for those indications.

I think the ‘controversy’ is more easily understood by realizing the historical changes that have occurred with the rapidly advancing CEREC technology over these past few years.

A few years ago just making a crown with CEREC was considered ‘revolutionary’. Being able to ‘capture’ existing morphology, or where ‘lost’ due to a fracture, etc. capturing a recreated ‘occlusion’ was THE only true method available. Notably, most of these were done one tooth at a time, even when the case needed multiple units. 

This is a KEY and defining difference between the old sw and the new. Before 3D we ONLY could take ’single’ images and needed to ‘correlate’ that single image against notably another single one which had the ‘occlusion’. Many devices, methods, techniques evolved to assist in getting these 2 images to accurately match. Then along came CEREC 3D. No longer were the images ‘confined’ to one-on-one…now one could take multiple images of the prep and have the sw ’stitch’ them together into a ‘virtual die’ which could then be ‘matched’ against another ’set’ of images for the occlusion (if one still used correlation) or notably against an occlusal record (the antagonist) to create multiple restorations off of the same die.

Herein lies the concern(s) which exist on many levels. The images need to not only consider matching the antagonist record, or occlusion (for correlation) but they need to be accurate enough to be ’stitched’ by the software into the individual dies. Many have found clinical difficulty with the transition from one image to multiple images, having grown accustomed to using devices for ’single image’ use, etc. and stayed with the one-on-one imaging from the earlier ‘correlation based’ methods.

This is a perfectly sound method, with much clinical basis, and training available to support of those techniques, so long as one confines their CEREC use to single crowns (which notably many do). BUT, a big opportunity to utilize CEREC to its fullest advantage is for those cases where necessarily more than one restoration need to be created in a quadrant. In those cases database/antagonist REALLY defines its potential over the older correlation methods. Even using correlation in quadrants, or doing ‘alternate’ teeth, etc. (which are merely ‘workarounds’ to allow one to use the earlier correlation one-on-one methods for multiple units) the efficiency, accuracy, and results I have personally found to be distinctly in favor of using database/antagonist.

What I have witnessed regarding the ‘adoption’ of using database/antagonist over correlation is curious and highly revealing. It seems that ironically the more ‘inexperienced’ the CEREC user, the more likely they will -want- to use database/antagonist, and very interestingly they are FAR more likely to be successful in learning the essentials of how.

Why is this? Probably because many of the more experienced users having spent considerable time, energy, and money in learning how to use the correlation one-on-one methods. The use of devices designed to assist with accurate images with these one-on-one images is FAR less practical with the multiple sequential images beneficial to 3D. Many of the ‘rules’ that were necessary with earlier systems dont apply with the new approach, and even a whole new set of elements now apply. So it makes sense really..many seasoned users ask why change? Newer users did not have that bias, by definition they were ‘open minded’ and as a result were notably easily taught how to successfully use database/antagonist very quickly…while veterans struggled trying to make the necessary adaptations required for its successful use.

So necessarily the biggest clinical challenge apparently is to get the images required that could yield accurate results. There are many new concepts which enable that, and notably they are distinctly different than the products, and methods that many veterans have used over years which further explains the reluctance, even resistance to explore this newer method to its fullest potential.

Its seems apparent, and natural I guess for many to ‘compare’ the newer techniques directly against the older ones. While this might be appropriate for determining how the 2 directly compare it conveniently overlooks the potential of the newer methodology which can be huge.

Realizing that the biggest ‘variance’ between those successfully using database/antagonist and those struggling is how clean their multiple images are, I plan to spend future time in reviewing helpful tips learned and honed clinically to that effect. While it makes common sense to take the fewest number of images needed to generate the result, that should not be confused with taking so few images that the sw simply cannnot accurately use the information to avoid the plethora of problems that typically seem to arise (read while its fascinating to note what the system CAN do…its NOT ‘magic’)..GIGO never meant more with CAD CIM dentistry that it does today with CEREC 3D.

I personally have found, and therefore believe, that one can predictably, routinely, and easily take the required images to create excellent restorations ‘built’ by the system itself (database vs correlation) in margins, contours, and occlusion. The ‘liability’ of taking more images can EASILY be offset by following guidelines designed to minimize that inherent and logical ‘liability’. In other words…IF.. the images are ‘clean’ the system CAN routinely do amazing things. Getting those ‘clean’ images is not difficult. Perhaps its fair to say some of the necessary nuances are distinctly different enough to seem uncomfortable to those with a lot of previous exposure to earlier methods, but certainly they are easily learned as directly witnessed by the many worldwide who have adopted them without ANY prior knowledge, or experience with CEREC.

Ray Becker