Dr James: 0:46

Yeah, hey, everyone, welcome back to the Dentist Universt podcast, an exciting one today, a bit of a turn from our usual content Hyper useful to dentists, especially useful to dentists because we're going to talk about finance and profitability, but within clinical dentistry and more specifically implants. And I'm joined today by Dr Pav Kera, a well-known face, face of the dental implant podcast, of course, which you guys will have seen no doubt before at least the implant fans and the audience and I'm so excited today to learn everything and anything about implants because I still find this stuff fascinating I still do to this very day. Pav, how are you?

Pav: 1:31

I'm very good, james, thanks you. Thank you for having me on. Yes, it's, I am the face of unfortunately. I'm the face of the dental implant, the voice the voice was a better term, maybe the voice. Yeah, I'm still not the intro voice, unfortunately. You heard that. Right, that's the master of that we call Morgan Freeman. I'm not going to lie, it's not actually Morgan Freeman, but it's a damn good impersonator for him. And I've actually had several people who were like, what is that really not Morgan Freeman? Is that what you think? Like I am Morgan Freeman. I wish I could.

Dr James: 2:06

That's cool. You know what I need to up my game when it comes to intros, because that was a particularly cool one.

Pav: 2:12

Anyway.

Dr James: 2:12

Pav, there'll be some people out there who know you and some people who are yet to meet you. Maybe it might be nice if you did a little bit of an intro for those people in the ladder category.

Pav: 2:20

Yep, no problem. So I graduated from Guy's Hospital back in 2002. Well, technically I entered it when it was UMDS, so it was Guy's Incense, thomas's, inverted Commerce merged with Kings in our second year and graduated in 2002. I did a lot of different courses. You name the course I've probably done it Okay. So I've done Mike Wise's restorative courses and Chris's all the aesthetics course. I've done hands-on courses on veneers with David Bloom. I went across to America to learn from Frank Spear, howard Chaslin. I did courses on acupuncture sedation and he just got to the point where it was something personal for me. So my grandfather in his later years he wanted me to help give him fixed teeth. This was before I was placing implants and I was really, really close to my grandfather. But I didn't know how to do it and he disclosed with me quite a personal secret. He turned around and said that look. He said I can't eat with the family, he said because my teeth hurt so much. He said I've got to take my food into my own room so I can take my teeth out and eat by myself. That's kind of like what spurred me to start down the implant route. So in my mind now, every patient that I help either directly or indirectly is in his memory. So kind of over the years I started to graduate, started to gravitate not graduate started to gravitate more towards implants and that's kind of like all I do now. So over the years it's I've done again a number of different courses, got my Mclendent in implantology, been very, very fortunate to land in a position in with a company where all we do is full arch all day, every day. I do that four days a week and one day a week I teach, mentor or do singles and that type of stuff. So I am on my podcast. I refer to myself and, for those who are as passionate as myself, as titanium nerds, so I was, I'm as titanium nerdy as they come. They don't come any titanium nerdy of them myself. So that's that's kind of like my, that's kind of like my background I am. I'm now at a point where you know I can do full arches proficiently. Zygomatic, quad zygomatic I'm getting more and more into as well and I'm really quite comfortable with pretty much all aspects of surgery. I guess the point when you're immersed in it that much, it just kind of like you start to enter flow state and that's when you know that you're doing something right and that's kind of like I'm fortunate to have been exposed to enough of it that that's kind of like where I am in my work now.

Dr James: 5:09

Titanium nerds. I love it. I was trying to think of the finance equivalent and it would be finnered, but it is quite as cool as the titanium nerds. The titanium nerds I like that, you know. Here's the thing about courses. So when you go on a course or when you read a book on a subject, what you have to remember is that is the distilled knowledge of the person who either authored that book or who has designed the course right Now. The thing about it is, when you come to distilled knowledge, how that looks in reality. To attain that level of ability or understanding is reading an absolute flipping ton of stuff over many years to get to that point where they have that level of refinement and also testing things out. And this is a really cool thing about courses and how we look at them is that you can learn it effectively and maybe like two days, what it probably took someone years to learn. But here's the one thing if we go on one course about one specific thing, it means that you have this one little window into the reality of how to undertake that procedure. The more courses you go on, you actually get to see it from all these different angles. You have all these different windows and think of it like a sphere or a football. If you have one sphere into the football, you can see a lot. You can see what's in front of you, but you can't see what's actually closest to the window. You can't see the information, you can't see everything that's in there. Are you with me? When you have other windows, you can see other sides, and what it means is you can pull out the best bits and throw it all together in your practice and also in your own courses and your own programs as well, and that's why I'm a huge proponent of just flipping, throw on yourself at something like what you've done, basically when it comes to implants. So hats off, mate. Well, well deserved title of Titanic nerds, so respect on that one. And then that leads us very nicely into what we're going to talk about in this podcast today, which is implants, but with a little bit of a twist how anybody can make it more profitable in their practice. And what we have to remember is the reason why I love podcasts like this is the information is so actionable. You can listen to myself and Paav for about 30, 40 minutes and have things that you can take into clinic literally tomorrow and use to become more profitable. And here's the thing. It's not about having all this money so you can be like, yeah, look at all this dosh that I have. It's about being more efficient, putting the same amount of time in and being remunerated to a higher level. Just because you make more money doesn't mean that you have to charge the patients more money. It can be just a case that you're more efficient with your time, and then what that means for you is you can reinvest it back into the practice, make it better, do whatever you want. Taking money is all about intention, and I'm really interested to hear how you personally go about this today, Paav. Let's jump straight in. Let's talk about efficiency, which is what I hinted at just then. There is always ways that every dentist can take their efficiency to the next level. What have you seen? What are the things that you see daily that dentists could improve? Let's talk about outside of the procedures. Let's talk about outside of clinically for the moment, maybe just surrounding the dental surgery front of highs, blah, blah, blah, stuff like that. What are the things that you see, the things that, if you had a magic wand, you could just wish you could just go out there and fix them in every dental practice.

Pav: 8:24

Yeah. So probably one of the first things is I noticed this a lot as a peripatetic surgeon, so I go I used to go from practice to practice, because you get some practices where the staff are really really good at priming the patient before they come in to see me, and other practices they weren't so great at priming the patients to come in to see me, which meant that sometimes I'd been a mixed practice a patient would come in to see me for an implant consultation and the patient, firstly they wouldn't be suitable because they'd have perio in their mouth. So it's like you know firstly you need to go see a hygienist and secondly, you'd spend 20, 30 minutes speaking to the patients about implants and you give them. You say, oh, what do you think? And the patient's like, oh, yeah, this is great. And then you hit them with the feet and they're like, oh, but I don't pay for my treatment because I think they can get it on the NHS exempt. One of the main things that you can do is have a little bit of training to your staff so that the patients are primed coming in, so that they know approximately. They don't have to know the full ins and outs of it, but they should know approximately what an implant is kind of like, how long it's going to take until a ballpark figure. So a lot of dentists will turn around and say to them that you know, we can't give you a figure without seeing you. Now, you can't give an accurate figure without seeing somebody. You can give them a ballpark figure so you can turn around and say to them look, assuming your case is relatively straightforward, it's going to be between this and this. If it's more complicated, the fees are going to go on. So what will happen then is that in itself will increase efficiency because you're wasting less time with patients. Patients kind of already come in knowing what you want to do, and for those patients where they can't afford it or it's not what they thought it was going to be, they've already been weeded out. I think the next step, above and beyond that as well, is making sure that you need to understand the theory. You need to be 100% confident with it as well, so that you can treatment plan effectively and efficiently. This means that when you're doing a treatment plan, it should take you five, 10 minutes. I can quite often now look at a case and in my mind it's just comping. This is exactly what we need to do. Now I'm not saying how five minute consultations with your patients, but what happens as soon as I look at a patient is I've got a pretty decent idea in my mind what I'm going to do without having to fully work it up, and the same comes from treatment planning as well. So I have kind of proformers that I use, and the proformers are editable, which means for me to get a completely bespoke consent form and treatment plan out to a patient is a three, four minute job, but that letter is several pages long. It is very, very comprehensive. So for my aspect is just making sure that it's all right going into a practice If that practice doesn't know anything about implants. You're immediately starting. It's like trying to ice skate uphill. So there has to be a level of education within the staff and then within you need to be confident in your treatment planning as well, and obviously that treatment planning starts with the basics. So it's like, oh, it's a single tooth, it's a healed side. This is kind of what I'm going to need to do, but over time and with experience and with more training, is that should start to extrapolate out to more complicated treatments as well you should be able to. A good surgeon can look at something and eyeball it and have an 85, 90% rough idea what needs to be done, just from a quick glance. I'm not advocating that that's how you treatment plan. I'm saying you need to have that level of confidence that, okay, I know this works, I know that doesn't work. We need to do this, this and this. This is kind of like the treatment that I've got going on in my mind, so it's keeping the overall planning effective as well, as opposed to going home and writing treatment plans for three hours every single night. It's not the right way to do.

Dr James: 12:40

It Should be spending time with your family, not writing treatment plans 100% and it's easy for that stuff on the back end to suck up your flipping all your time effectively. You know what, when I was working in my very first dental practice, there was a guy that came in and it was NHS, or at least it was like 98% NHS. And this guy came in and he wanted implants because he'd lost all his teeth. And the receptionist said, oh well, it would be a private treatment, it wouldn't be available on the NHS. And the guy got indignant, as patients tend to do sometimes when they don't have this priming that you're talking about and he said but how much does it actually cost him to make these things? 50p, something like that? And I was like, dude, this is sometimes what we're up against a little bit, you know, but the things that you're talking about are going to overcome that, help overcome that, and particularly as well, actually as a pre-partietary dentist, when you're working in practice, they don't actually do implants normally and you stepped in there on a, on a, just a one off thing. I can imagine that that's something that you come up against.

Pav: 13:43

Let's have a half day training session with those practices. This is what it is, so it's clear in their minds.

Dr James: 13:52

Gotcha, gotcha, gotcha, gotcha. Let's step in to the chair. Now let's step into the surgery. What things? These are the hyper useful things, okay, that are really, really, really specific and granular to what we do on a day to day basis. Let's step into the surgery. Let's look at treatment planning procedures from the dentist perspective. What are the things that you often see that you just wish you could improve, wish you could help dentists with in order to achieve more efficiency?

Pav: 14:23

Sorry, just just ask that slightly different way. So I understand. Make sure I understand it.

Dr James: 14:27

Oh, all I meant was so let's talk about procedurally and clinically, like working with a dentist on how their treatment plan in their cases or the actual procedures themselves, how they can be more efficient in order to minimize time and therefore increase profitability.

Pav: 14:48

Yes, that makes sense. So whenever you start a new procedure, you're always going to be slower to it. Okay, always, always, always. The first implant that I did it was a single implant healed site took me three hours to do and the implant was completely unusable because it was in the wrong position. Okay, Now that same implant would probably take me six minutes to do, but it's taken me 15, 16 years to get to the point, and it's also taken me 250,000 pounds worth of education to get to the point where I can do it in six minutes. So it partly comes down to building confidence with your education, making sure that you understand it. And this goes back to one thing that we spoke about previously is if you go on an implant course which is sponsored by this particular implant company, you're not going to say anything bad about that implant company All of a sudden, that implants are best. Everything else is a load of rubbish. That's not how implants work. You need a true, deep understanding of all aspects of implants, of all different implants, so that you can understand. Well, you know, okay, this works here, this works here, and I can use this like this and this like this, so you should be able to chop and change.

Dr James: 16:04

Can I just jump in just for 10 seconds there? It's always such an interesting coincidence that when you attend those sorts of courses that they do the independent studies, and it just so happened that that Brian came out on top. How interesting is that. What a coincidence it's always the case.

Pav: 16:20

So what will happen is, the more you educate yourself, the lesser that marketing bullshit will be shouting in your ear. Okay, so you'll become more confident in your treatment planning, regardless of what, of what implant system that you're using, and you need to truly understand your implant system. Okay, when you understand your implant system and you start to do it on a daily basis you do it day by day by day by day by day you start to build up muscle memory, and this is something that I've spoken about in my podcast quite a long time. Okay, james, this is true of any aspect of dentistry. Okay, when we were at university, right, it used to take us an hour and a half to do an occlusal amalgam. Yeah, how was the first time around.

Dr James: 17:08

My first feeling, class five GIC Okay, the guy had nine millimeter recession, right. I think we got the cervical margin one and a half hour, something crazy like that I remember.

Pav: 17:20

And then you're so proud by the time you get to graduation that you know you can do an occlusal amalgam in an hour. Then you get thrown into the lion's den of NHS dentistry, where you're given 10 minutes to do it Okay, and you just build up that proficiency over time. It doesn't happen instantly, okay. The same is true with crown preps and absolutely everything. So what I would say is don't bash yourself. If you're new to this, okay, but if you're not new to this, you should be starting to see your placements becoming more precise and faster as well, okay. So this goes back to the second aspect that I was talking about is that knowledge will not only help you with your treatment planning. That knowledge will also help you with your implant placement as well, because you're not double guessing yourself during surgery. You're not looking at it, going what am I supposed to be doing here? Am I doing this right? Is this deep enough? Is this at the correct angle? You're looking at it and you're going yeah, that's where I want to be. Bang, put the implant in stitches in and you're done. Okay. And that comes again. It just comes with experience. You just got to do enough of them and have enough confidence, and the confidence comes from knowledge and repetition effectively. So for me those are kind of like the two aspects which are important up to the point of placing implants, but then the same become. You need the same level of efficiency when it comes to restoring implants as well. For the sake of simplicity, let's talk about a straightforward single implant. Okay, let's not talk about anything complicated. Okay, here's. I've got friends and colleagues where they'll turn around and they'll say to me I book 45 minutes to an hour for impression of the implant. And they said I'll book another 45 minutes for when the crown comes back so that I can fit it. And I'm sat there scratching my head because for me to do an impression, I book out half an hour, and of that half an hour I'm twiddling my thumbs for 10, 15 minutes because I'm finished. And then when it comes to fit is, you know, I get to book out half an hour for a fit, but it actually only takes me about 15 minutes to do. I would look at a little bit longer in case you get thrown a curveball that you need to deal with. That's all that it is. And again, I think that comes down to I'm not being arrogant when I say that I can do it that quickly, I'm just saying that you know, I understand what I need to do, I understand my implant system and I've done it enough times that I've built up that muscle memory. Now when you put in the impression the impression coping on the implant, it locks in in a certain way. That's how you know that it is and to start with you don't know what it feels like, but then after a time you can do it with your eyes closed and you know, because it comes down to muscle memory and repetition. So what I'd say to everybody is you know, don't jump from one implant system to another, to another, to another, just because you get, you know, a free surgical kit with 10, 15 implants that you base. Pick a system that you like and you know, practice with it and get quicker and more efficient at it. So those are, like some of the main things that I think really needs to be done. So for me, the overall clinical time for a single implant, including impressions and fit, should be no more than an hour and 45 minutes for everything including the surgery. So that's that surgery, impressions and and the fit as well accumulate that all together hour and 45. It's more than enough.

Dr James: 20:51

Interesting. You know what, pav? Something just popped into my head when you were talking there. Implants not my forte by any means. I know the bare minimum about them to get by. I know how to probe them, or at least. Well, the implantologist tell me that you shouldn't probe them really if they look healthy. Am I right in saying that?

Pav: 21:09

Yeah, it's a bit more intricate than that. Okay, and there's a number of different schools of thought.

Dr James: 21:14

I probe them. Okay, fair enough, because I've heard people say both and then I've heard people say plastic probes. Anyway, we digress entirely. So my realm of knowledge would be more restorative. And I talk to dentists sometimes about how much they're charging for a crown and I hear such a disparity. Okay, I've heard people charge in private coins 250 quid. Okay, no, all the way up to 1200, right For Emax is posteriorly. Let's take the same conversation and talk about implants. Let's take exactly the same conversation and then turn it towards implants. Is there like a bare minimum, is there any rules of thumb that you can give dentists on charging appropriately?

Pav: 21:55

Yeah, there's no rules of thumb. What I would say to you is the average cost of an implant is floats around two and a half thousand pounds for everything, and ironically, it's been that for about 20 years. Okay, it's a place into consideration. Is that actually being eroded? But on average it's anywhere between 2200 on average and up to about 2,600 approximately. There's no lower limit. So what I know a lot of people do, a lot of the cheaper clinics as well, is they'll charge a ridiculously low fee for the implant, and that's to get the patient in through the door. They'll turn around and say, oh, the implant is 700 pounds, but you've got to pay for the cover. Screw the heating abutment, pickup abutment, the crown, any bone grafting. You've got to pay for stitches in some of these clinics as well, and by the time you add it all together, it's almost at the same cost. And then what you've got is you've got an upset patient who thought they were only going to pay 750 quid for it. Now it's come out at two grand. So and this comes back to what we were saying a few minutes ago Okay, if you want to drop your fees, there's no point. There's no harm in doing that, but it's better to do that when you're quick with it, because your hourly rate is maintained or improved, you know. So if you get faster at something, you can afford to do it a little bit cheaper to do more of them.

Dr James: 23:20

Yeah, yeah.

Pav: 23:21

Okay, yeah, fair enough, I've done the opposite. I've gotten faster, but I charge more as well, because I'm damn confident at what I'm doing.

Dr James: 23:30

Here's the thing I actually feel that if you're able to do it faster, is there not a school of thought that says you might be able to charge more because the value is higher? If you think about it, patients won't be in the chair for the minimum amount of time possible. They want the job done, but they also want to be in the chair for the minimum amount of time possible. If someone takes a tooth out in two minutes versus 30 minutes, right yeah, to me the two minute thing is the two minute one is more valuable because it's done like that.

Pav: 23:56

Yeah, same for me. It shows experience. The provider being is assuming that the clinical outcomes are good. We're not talking about cutting quarters for the sake of cutting quarters. It's a drop in a little bit. We're talking about maintaining or improving standards, but doing it quicker. And yes, I'd be the same. You know, if I needed a procedure and somebody tends to me, I can do it better and faster, but you're going to pay more to go for it.

Dr James: 24:25

Here's one quick thing before we move on. You know, in dentistry, right, let's set the fee aside. I mean, let's say you're charging 1700 for an implant. Let's say you're charging 3000 for an implant right, to a lot of people, that's a lot of money either way right Now. Here's the thing in dentistry, the patient is actually only ever upset about the cost if it doesn't work. You ever noticed that? That's when they throw it back in your face and they say, hey, I paid all this money and it didn't work. Right Now, if you're really slick at implants, right, your failure rate is, you'll know better than me. But let's say it's like 0.1% or it's very low. Now, I just pulled that number out of the air. I'm sure there's some stats on that somewhere. So think about it like this right, if you're really really really good at implants, let's say your failure rate is 0.1%. Right, let's say you're charging someone 1700 versus 3.5,000, right, you're still going to get the same complaint rate. Ok, because it's almost irrespective of the price. Yeah, 0.1% of people would have complained either way. And I'm not saying we should all rush out and change the prices. It's just another way of looking at things. You with me.

Pav: 25:31

Do you know what's really interesting? Most of my complaints came from the patients who I charged less for. Yeah, yeah, yeah, because sometimes what they do is.

Dr James: 25:44

I think I know the answer on that, because sometimes they put two and two together and get five, and what I mean by that is they think this guy cut corners because he did me a favour. Anywho, food for thought. Let's move swiftly on to the. We wanted to talk about soft skills as well. Pa yeah, soft skills. How do we present implants as treatment options to the patients? How do we do that so?

Pav: 26:08

you know, soft skills are really, really important and this is something that, historically, I struggle with because my personality type is that I'm that direct-to-type personality. Ok, I'm like bullet point it. That's all I need to know, don't waste any more of my time. And historically, that's kind of like what I've done with patients, and patients will be like wow, that was like no information at all. And you know a lot of the soft skills now is I try to spend a lot longer in the procedure talking about the pleasant. Now, I'm a really big introvert as well. Ok, it's like. You know, it's like lockdown was heaven for me, because it was just like I was one of these people that you know. As they were talking about lifting lockdown, I was getting anxiety because I was like, oh crap, I'm going to have to actually start to interact with people again. Ok, so for me, making small talk is really really difficult, but it's not about me, it's about the patients and it's really important to the patients. Ok, because for me it's just an implant. It's just like OK, it's it's my two o'clock appointment on a Wednesday afternoon, but for the patient it might be. I'm really nervous about going to the page or don't go into the dentist and he's cutting into my head and he's going to put a screw into my head. You know they need to make sure that they are comfortable with the person that's doing it for them, and the only way that they can build up that rapport and that trust is for your soft skills to be appropriate as well. And you start to. When you do this enough, you start to Judge from the patients quite quickly, kind of like what their personality type is. Ok, some people like a lot of information. Some people, like me, just want the bullet points. Other people they want a long appointment but they don't really want to talk about the procedure. They want to know what you're doing this weekend and where you're going on holiday and things like that. So it's tailoring it to the to the patient OK. But that also means effective communication in how you're speaking to the patients about the procedure as well. Ok, and this is I think this is a really big block that dentists get themselves into, not only with implants but all other aspects of dentistry as well. Ok, they talk about the procedure too much. Ok. So they try to do the consent in that entire process as well. So it's like, ok, you want an implant. Let me bullet point all the pros, let me bullet point all the all the cons, let me go through all the all of the alternatives and let me go through everything that may go wrong. And all of a sudden, patients like I wanted to fix tooth and now you've told me that I'm you know, I may have nerve damage and I may go numb forever and you've lost them, ok, whereas what you need to know is you need to find out why does the patient want this? Why is it important to them? You know, it might be a simple, and I've had this before where people have come to me and turned around and there was one lady, quite recently actually, she said she said I need to have implants. And I said, well, why do you need to have implants? And she goes my daughter's getting married, she's embarrassed of my smile and she said I'm not allowed to come to the wedding unless I have my teeth Right. So now I know what's important to her and I'm not using that to manipulate her, but I need to understand what's important to her, because if I say to her, yes, fantastic, let's get it done when we talk about this, but I don't get it done in time for her daughter's wedding so she can actually go. She's gonna be unhappy, but the outcome clinically is still gonna be the same for her right. So don't overwhelm the patients too much with too much clinical jargon. Your conversation should be present there, should be short and succinct, and they should be using patient friendly languages. You right, google dental implants and find out whatever websites come up and look at how many of these websites start talking about drilling into the jaw bone and putting titanium screws into the jaws. Patients don't wanna know that, right, they don't need to know that. They need to know it's the best thing that we can give them to having their own natural tooth back once their tooth's been removed. Not that I'm gonna cut you open, I'm gonna drill into your jaw. I wanna squeeze this titanium screw. And, by the way, when I squeeze this titanium screw, I may cause you permanent nerve damage. It's patient unfriendly language. We need to use patient friendly language. Then what you can do is, using that patient friendly language, you can prime them again for what may happen in the future. So I will turn around and I say to my patients look, the only thing that I can promise you is I will do the very best that I can for you. So I can't promise you that this procedure's going to work. I said because 1% of the implants that I place don't take. I said sometimes we can figure out why. Other times we can't figure out why. I said if we can't figure out why we wait for it to heal, we'll go back in and do it. Every time that we do it there's a 1% risk that the implant's gonna be rejected by your body. So if you don't like the sound of that, it's really simple don't have the procedure done. Then, occasionally, when it happens, then the patients are just like oh well, you know what you said. This might happen. They're never 100% happy with it, but at least it's kind of like they're primed for it.

Dr James: 31:25

Can I just jump in two seconds on that one? Here's the one thing I used to say to my patients all the time, and it's a really nice way of reframing everything. And I say, listen, there's only one thing that's for sure If we don't do anything, everything stays the same. Yeah, oh, they're on board straight away. They're like, doc, you've totally put that in language that I can understand. I totally see now that we gotta do something. What are my options? And then I say, absolutely right, the chance this is one's gonna be root canal extraction, monitor, whatever that is, whatever we decide to do. And this way there's a chance, the best chance possible, that we can get you the result that you want. And they love that. And they don't have to go into the flipping million, billion, trillion things that you can say, all the ins and outs. They just wanna know the outcome. People just wanna know the outcome. And you're totally bang on. The dentists were so detail-oriented and we love procedures we actually love procedures, okay, and we love proformas and all of that stuff. Right, and that speaks, because that's how we think. That slips through into our descriptive language to the patients. Patients don't wanna know they just wanna know what the outcome is, and, if you can, you tell them they say like that lady for daughter's wedding. And then what you can say is what this will mean is that you'll have fixed teeth and when you attend your daughter's wedding you'll be able to smile. Yeah, absolutely, something like that. Yeah, With confidence. If you wanna chuck that in as well, so that's brilliant. And you see that one little thing that I promise your amount of patients, the amount of patients that you're able to serve through your skills, will literally skyrocket by these little tiny tweaks in our language. Anything else to say on that one, pam, before I jumped in there, sorry.

Pav: 33:06

No again, soft skills is not taught at university. It's not something that comes neptary for me, but they're probably as important, if not more important, than the hard skills, because if you don't have the soft skills, you're not gonna be doing the technical work anyway, because patients won't like you, they won't wanna have it done.

Dr James: 33:24

This is the thing about dentistry as well. You can be a god of implants and the odd implant won't work right, and that's when some patients will perceive that as you not being clinically adept, even though they've had that explained to them. And the plan B in that case is the report you have between them. So that's why, for every single patient, always sewing if you can do it naturally, if that's who you are, okay. And for those out there who it doesn't come to so naturally, sewing those seeds of report, it's a smart thing to do on many different levels. So food for thought. We talked about preventing problems earlier when we were talking about efficiency, because that is obviously that, something that leads to us being more efficient. What about when we've actually placed implants? What steps can we take during the procedures to ensure that the longevity of the implant is as long as possible? And we've basically prevented problems prospectively as well. What gives those best implants their longevity?

Pav: 34:30

Okay. So I think what's the best way to explain this? I think it's just studying and understanding the art and science to a ridiculously high level. Let me explain this now. Okay, yeah, brilliant. So what happens is when we first learn to place implants, it's normally, you know, a lot of private courses are. You go once every few weeks over 12 months and it's kind of like, okay, you know enough to do the basics. It's kind of like, off, you go and then a lot of people start placing implants and they don't really do that much more education afterwards. Okay, a lot of the tips and tricks that I've learned to improve my success rates and improve my longevity is because I've done a really deep, deep dive into the science behind it. Okay, and there's an old adage where people turn around and say you give a good implant surgeon a screw from B and Q, we can make it work. That's true, okay, and an inexperienced surgeon, the most expensive implant on the planet, they're not going to be able to make it work. Again, true, because it's not just the implant itself, it's how it's executed. It's the it's the it's, depending on what you're doing. It's the medications that you prescribed before, during and after the procedure. Okay, it's how. It's how you suture and how you tie the sutures and how much strength you put into the sutures as you're doing it. It's your drilling protocol that when you're drilling and you're getting tactile feedback from the bone, it's okay. It feels like this. I'm therefore going to modify what we call the osteotomy, which is basically the hole that the implants going to sit into. I'm going to change the shape of that. The implants the same, but I'm going to change the shape of that because of the tactile feedback that I'm getting from the bone. And then it's, you know, it's, it's little things like, you know, making sure you're using a good lab, because a lot of people they'll, they'll to try to keep their costs down, to be competitive, they'll use a cheaper lab and have more problems. Yeah, and that's that's. That's another issue. So again, I don't restrict myself on lambs. I find lambs that just do the best job, what they possibly can. I just pass that cost onto the fee, but feel that fee onto the to the patients. But again, I'm in a fortunate position where, you know I'm I'm that busy that I can afford to do that to patients when I speak to patients again, not with arrogance, but with just pure confidence. We want me to do it. This is my fee. If you want cheaper, I can guarantee you can get cheaper elsewhere. I said, but if I do cheaper that means I've got to cut corners. I said I wouldn't be happy doing that for me, so I'm not going to do it for you and for me. That that works really nicely. So again it's it's understanding implants to such a high level that you tweak your, your surgical procedure and your restorative procedure accordingly in order to achieve these long lasting results. That's what it comes down to, in my opinion.

Dr James: 37:28

That's phenomenal, man, thank you. And you know, when you talk about that stuff, you get passionate, bro. You get flippin' it's head in. You do, man. It's awesome. I tell you, nerd, I love it, I can see it. It's cool, bro, I really appreciate it, and you know what. So all those things that you said right, let's say here's, here's what was popping into my head just as you were talking. Right, let's say, you had a top three, okay, and no particular order. It's not easy for you to put the top three things that dentists could improve on together. Is that something you could do off the cuff right now, because that I would find that really interesting?

Pav: 38:03

Yes, so, firstly, I would say knowledge, because it will improve all aspects of your, of your treatment planning. And again, that comes down to quite often people just do one or two courses, so they will be taught one way to graft and or they'll be taught one way to place implants. So the more knowledge you have, it just empowers you more and more, okay, yeah. Secondly is understand your implants and do enough of them so that you can build up a really good muscle memory. And then what happens is is, if something happens during surgery, is you can almost feel it going wrong, or you can feel it going right, and then you can manipulate what you're doing on the fly to improve the patient outcomes. And sometimes things don't go according to plan. If it doesn't go according to plan, you need the skills and the knowledge to be able to, to be able to to to correct it, okay. And then the final one I would say is soft skills, because the best better your soft skills, the more people go excuse me, go ahead with treatment, but B the more is if things go wrong, patients are generally more forgiving if you built up that, that rapport with them. Not everybody's going to be, and what we're finding is patients are becoming. They're becoming more demanding now because, I think, because of the economy, because they feel that they're parting with their hard-earned money, so they want even more value for money. So we have to up power games still. So, knowledge, the doing enough and understanding your system inside out and back to front, and then having the soft skills those, those are the main three things I would say would start to improve overall profitability and efficiency very, very quickly.

Dr James: 39:48

Boom, boom, boom. One, two, three. I love it, my man, and you know what you know when it comes to this sort of stuff, the reason why I really love podcasts like this. There's two types of there's two types of investing. There's investing where we grow our capital long-term and it really takes years for us to see results. And then there's the things that we can talk about when it comes to investing, and one of those things which is investing in ourselves, investing in our knowledge that you can literally go to work tomorrow and make more money, and that's the sort of thing that we talked about on today's podcast, and that's why these are so flipping powerful and I have absolutely 100% faith there's probably about a million billion trillion things more like that in your head. Oh yeah, oh yeah. This is the tip of the iceberg. Pav is on the group, Dr Pav Kera. That's K-H-A-I-R-A, and Pav, you run courses for dentists which help them improve their clinical ability in implants and also profitability as well, I believe.

Pav: 40:45

Yeah, so what I'm doing is I am putting together an online training platform and I've got a launch offer. At the moment. The website is academyofimplantexcellencecom, and it's just because I'm passionate about it. You know a lot of my mentors. They were trained by PI Brandemark himself, okay, and they have Prof Brandemark's philosophy within them, and then they've then instilled Prof Brandemark's philosophy within me as well, and that philosophy is really quite simple is we need to teach other dentists genuinely as much as we can about implants, because that way we get to help more patients, the outcomes improve and the science progresses. If I teach just a little bit of my knowledge, then who's that helping? Absolutely nobody. Whereas if I put everything that I have into it and dedicate myself and impart as many pearls of wisdom as what I can, everybody starts to benefit, my mentees benefit and ultimately, the patients will benefit. And that goes back to the promise that I made to my grandfather, to myself and in my grandfather's name. And again, this is one of the reasons why I'm so passionate about implant dentistry and about teaching, because I just love it. I could just talk titanium all day. I'm sure I sleep there at night time, you know, kind of like great for titanium, that's awesome. The wife's going to be, you just go to sleep and switch off about implants.

Dr James: 42:21

Well, after ask your wife, won't we? You know, it's funny, actually, because I was in. I was asleep the other day and I was, there was someone else in the room and apparently I said I can't remember exactly what I said, but it was something along the lines of finance when I was barely conscious, and she was like I know that you dream of it, James, because you speak about it while you're asleep, which which is quite funny Really. I didn't think that was a thing, but there we are, Pa. Thank you so much for sharing your knowledge, Bro, flipping tons of gems in there. Big respect. I love your passion and looking forward to getting you back on the podcast very, very soon and I hope we have a smashing day. See you later, Take care.