This week, Prav and Payman sit down for a chat with a dental and implantology leader from a short hop over the water in Northern Ireland.
James Hamill chats about growing up in Enniskillen, NI, and how his entrepreneurial mindset led from practice purchase to eventual burnout. But it’s not all doom and gloom: James talks about how close relationships with patients and an inspirational figure provided a ray of light.
James also reveals how he blagged the NI distribution rights to innovative US implant guidance tech, Chrome, and gives the lowdown on how the system is making life easier for patients and clinicians.
In This Episode
01.39 – NI frame of mind
07.36 – Discovering dentistry
16.52 – Dundee
20.19 – Business
26.09 – Starting with surgery
29.31 – Marketing the business
34.01 – Lows
42.02 – Highs
49.09 – Time out and 3D printing
53.44 – Chrome
01.19.15 – Blackbox thinking
01.26.08 – Work ethic
01.30.48 – Fantasy dinner party
01.34.28 – Last days and legacy
About James Hamill
Multi-award-winning dentist James Hamill is the CEO of Quoris3D dental 3D printing and design tech company.
He is Europe’s leading Chrome GuidedSMILE guided surgery clinician and one of the foremost Chrome clinicians worldwide.
James is a fellow of the International Team for Implantology (ITI) and a prolific implantology teacher and mentor.
He holds a diploma in implant dentistry from the Royal College of Surgeons of Edinburgh and is a member of the Faculty of Dental Surgery.
I would argue quite strongly that what we’re teaching at the minute and implant dentistry, we’re teaching the surgical principles, which is lifting flaps and managing soft tissue, all really good, important fundamental things. But the bit we’re missing is to make sure that we put it in the right place. If we put it in the right place, we will reduce our surgical complications and we will reduce our risk of complications. That’s the position, and that’s where guided surgery fits.
This is Dental Leaders, the podcast, where you get to go one on one with emerging leaders in dentistry. Your hosts, Payman, Langroudi and Prav.
Selling cake gives me great pleasure to welcome Dr. James Hamill onto the podcast. James is a long time implant leader, is the way I would describe it. First came on my radar with blue Apple Dental. But things have moved on a lot for James. He’s a bit of a serial entrepreneur, teaches mentors, distributes near dental implants in Ireland, CEO, of course dental and recently doing a roadshow around the UK with his chrome product which is really taken off which is the implant digital workflow, which James you’re looking at now going across Europe. With pleasure to have you, buddy.
Welcome. Yeah, Yeah. Thank you. Yep.
So, James, do you grew up in Northern Ireland?
Yep. Correct. Yeah. Currently, Fermanagh, a little sleepy town called Enniskillen, which is over on the west side of Northern Ireland. So we’re, we’re, we’re known as border people. So we grew up on the border.
So Enniskillen to me, only the troubles. I remember Enniskillen coming up in the Troubles. Do you have memories of the Troubles being a feature of your childhood, or were you past that point when you were?
Very much so. Now you’ve brought that up. That makes me feel quite sad actually. But that that’s what you remember Enniskillen for? Yeah. Yeah. So Enniskillen was unfortunately made famous because of the Enniskillen bomb which happened which happened at the Cenotaph when when there was a group families, husbands and wives and kids there for the Remembrance Day period that took place there every year. And yeah, it was a very tragic time for me. Now that you’ve said that the memories actually of that flood back. Yeah. So we grew up in The Troubles. I suppose my generation was generation where we couldn’t we were restricted in where we could go. We went to Belfast. Everything was about. Was there going to be able was there going to be one of these calls that came in that you had to evacuate certain areas? But that’s what we lived with. So I suppose it was nothing unusual. It’s probably more unusual not to have it. And I’ve got two children, 18 and 16, and that’s amazing that they haven’t had to grow up in that environment. And thank God they haven’t had to grow up with that environment, you know, at. You know, I remember I stole so many stories, but I remember sitting in class and one of my very good friends being removed from the class to find out that his dad had been blown. Blown up. Right. But they are very close to the village that I lived in. And that still is a haunting memory of him walking out the door.
The normalisation of it, isn’t it? Because you could even say we grew up with it or I grew up with it because I lived across the road from Regent’s Park and there was the Regent’s Park Bomb, and I don’t remember thinking about this problem very much. So that’s all normalisation. I go to Lebanon a lot and it’s just been war and war and war. And it’s funny because you don’t think about it all day, but then sometimes there’s a big bang and suddenly everyone’s on edge. And it turns out it was some some opening of some garden somewhere that were firing, firing some sort of artillery thing to celebrate. But that sort of PTSD of of it.
You know, goes back suddenly. It does come back and. We live in a beautiful part of the world. Like Fermanagh is essentially the Lake District of Ireland and it is stunningly beautiful and that has just been emptied over the years. But Northern Ireland’s moved on. If we go more positive, you know, you know, it’s moved on massively and hopefully we continue to do that. There’s still the odd dinosaur in there who wants to keep harking back to the past, but we got to move forward and the scars have got to heal. And as a community, we’ve got to let things go, unfortunately. Or if we you know, otherwise we’re just polluting our kids and their kids. So I think it’s important that we got to keep, no matter how painful it is, we got to keep moving forward. And I understand that’s hugely difficult for for many, many families in Northern Ireland. But I also think we all are our next generation and the opportunity not to have that baggage.
James I spend quite a lot of time in Belfast in the last couple of years because we keep coming over for that many small make over course of us. And the the temperament of the Northern Irish seems to be sort of very self deprecating. Not not someone, not people who sort of shout out their their their sort of what’s great about them, sort of the opposite of kind of where I’m at right now, £1,000 down south. But in that environment, you’re a serial entrepreneur who entrepreneurs by their nature have to shout about what they’re doing. Are you an outlier compared to your peers in that sense?
Not Northern Ireland is full of people like me. And it is because you have to be you know, we don’t have chimney pots, you know, we don’t have masses of amount of population. And therefore there is innovative people and a not of businesses all over Northern Ireland. You know, if you look at Ireland as a whole, it’s the it’s the European leading medical device market, as I’m sure you’ll be aware of payment in your business. You know, and the side of Ireland, the innovation is incredible and that has been driven by governmental policies, but also because of the people that exist here generally, a very highly trained population, very good schools, like really good schools. So the education is is superb. And really what we have suffered from for many years is the dirty in a way the that is stopping and a lot of that’s been driven by cost of going to university in the UK versus staying in Ireland. And so I think we’re starting to see more people staying in house. An outlier amongst my friends, you know, a lot of people that I went to school with, lots of them are self-made business people. Lots of them have owned their own businesses at the time. Some have failed, some have been very successful. So no, I don’t think I’m an outlier in regards to that. Now.
Do you remember the first time you thought I was going to be a dentist?
Yeah, I do, actually. I was always going to be a vet, and I had absolutely no interest in the industry until I mess things up. So I at school loved biology, love geography, hated chemistry, and spent most of my time in chemistry. See, I never could hit the guy at the far side of the class with the what? I used to put the orange tube of the Bunsen burner onto the top and it made a very effective water pistol and it was amazingly accurate. And so I just masked in chemistry because I just couldn’t get on the subject. So unfortunately, I decided that I spent summers with vets. Very weird thing and rural part of Vermont. I suppose its normal enough and I always wanted to be a vet. So I guess the story as I got a D in chemistry the first time, so no veterinary school was going to accept me, although I would argue very strongly that it would make a good vet, but that wasn’t going to happen. So what what happened at that point was I remember sitting down panicking and I was going through clearing what can I get with two ears and the D what can I get with two ears and two.
A’s and what a combination.
Yeah, I know my dad. I was nearly signing up for marine biology. Like what? Where that came from? I have no idea. But remember my dad coming in and saying. Les, just hold on a second. You know, let’s not do anything Rush here. Typical of my dad. And he said, Why don’t you think about repeating your chemistry? So that’s what I did. I went to Belfast and my friends were going there from school to university, and I moved in with a few of them in the bottom of the Lisburn Road and unfortunately at that stage wasn’t mature enough to realise I had one year to sort myself out. So for the first six months I basically drank smokes, which is a wonderful drink from Northern Ireland. It’s a beer. We made Christmas trees out of the cans and I got another. Rd Okay, so at that point, at that point my mother and father extracted me from that and God bless them, they continued to pay their rent and move me in with my cousin Rodney, who had just started his accountancy career. So he was on down the road in Belfast. And, you know, I look back at Rodney still may account and a very dear friend, and he moved out of his bedroom, moved into a box room where the bed wasn’t long enough to cope with them. So he used to sleep with his feet up, you know, up against like this. And I got his bedroom and he said to me, If you don’t get a fucking falconer, he says, I’m brilliant. So I saw just the brilliant switched for me and I did every paper that ever existed in A-level chemistry.
And I got an A and came very close to the top band in Northern Ireland. So I switched it round and it was during that period that my mum suggested I think about dentistry. So I went and did some work experience with a dentist in Belfast. And the thing that struck me about that was the relationships between the patients and the dentist and that sort of thought, you know what, that appeals. I then went to see an orthodontist and then I gave the name of Henry Cassidy. You know, this is quite a while ago. No, but he ran a private orthodontic business. Beautiful. Ms. was so far ahead of its time. So he had four chairs, very American style. And then he had a consulting room. He was into bicycles. I liked bicycles. And I still remember the key moment for me was when he sat and he said, turn around to his nurse, and he said, 19. And I was wondering, what is he talking about? 19 And the nurse got up and plugged in 19 degrees into the air conditioning. And I just thought, Oh, that’s so cool, so cool. And then all the kids were set and playing with boys as he went round. So he just got up, put his gloves on, the gloves were setting, did his work, stood up, took his gloves off, went to the next chair and just went round the circle all day. And I thought, Oh, this is smart stuff. So at that stage I wanted to become an orthodontist and then grew to hate orthodontics. But that’s a good other story. So that’s when I realised I wanted to do dentistry at that point.
Either your parents involved in medical at all.
No, no. My mom is She taught special needs all her life. And my dad. My dad did lots of different things. So he he started in the military, much to his parents discussed. He left and then he went, became a sales person for oil. So he sold oil, distributed oil distribution. But that’s his whole that whole side. His father had an oil distribution business. He went and worked his and then his brother, he’s ten years older than Dad, took that business over, pretty much like going into too much detail. And Dad then ran the Enniskillen office. So he did that for many years and then he started his own oil distribution business. That didn’t go very well, but during that he bought a newsagents and we ran the newsagents as a family, all four of us. So he double jabbed, my mum, double jabbed, we went to school, worked on the shop, learnt how to chat to people, stocked the shelves, all that crack. And that was such a good thing for us, you know, when we look back and that the fun we had with that shop was absolutely brilliant. So we ran out and up, put us basically got us started in university and because my, my, my two sisters and me were all at one time, so I’m one of three, I’m in the middle. And yeah, so we all did that. And then he sold the shop. He then became a driving instructor and then he repaired dental offices. So you try and put that together. Make any sense?
The the entrepreneurial side of you are can he’s come from him.
Has, it has to. Yeah. But me and Prav talk about shop. I mean you might have heard it before but but but I honestly I put the success of both Prav and his brother down to the relationships in that show. Yeah. Does that resonate with you?
Yeah, absolutely. And then we worked in a local hotel, and again, myself and my two sisters worked behind the bar. Pollen paint, half on the crack. And, you know, myself and my two sisters, there’s nobody that you could put us in a room to room with that we wouldn’t be prepared to have a conversation with. And I think, you know, part of my parents genius, if they had it, was that they in all the quiet confidence in us and that has worked out has been great for us as kids and adults moving forward from that, that that’s what they give us more than anything else. Like we were not a wealthy family by any means. I think we had two holidays and our time as one to France and one to Portugal. But we learned an ethic of work, I can tell you that. And we learned an ethic of how to deal with people and be fair with people. And I think I think that’s been good. Did you did you stick long shifts in James in the shop with with her late nights, with her weekends, cash and carry trips, that sort of thing. Weekends, you know, the newspapers. My dad got up every morning and done the newspaper to turn some days you were in before you went to school for an hour just to help out. You were in after school. You maybe come home from rugby training and you get off the bus at half sick. You did an hour on the shop and then you went home and then Dad would maybe come back up to lock up. And then the weekends, usually Sunday was your busy day with the newspapers. I knew to in to set it all up prior to people coming to church and chapel and then, you know, you in on a Saturday she’d go play rugby and then come back from rugby going into a couple of hours. So we just all mucked in really I suppose was the way it left the penny choos.
You’ve done a lot of work with Chris Barrow. You’ve done a lot of work with Chris Barrow, and I’ve heard him say, and he’s absolutely right, that sometimes when you’re hiring, if the person you’re hiring has got a history of family business, that’s a great thing because they understand the sacrifice that it takes to run a business.
I Yeah. You know, the guy that run anyway. Yeah, the guy that runs Quintus. There’s a guy called Ian and he’s an old school friend of mine. And Ian comes from family business, from rest, the restaurant trade. And, you know, these people can turn their hands down, I think, given their time, because it’s inbuilt that drive is just set within stone. And that’s not something that you can train somebody with. You know, we’ve all been there, we’ve all hired a few lemons along the way. But you know, those people that have got that core fight, you know, they’re worth their weight, these people.
So you then studied in Dundee?
Mm hmm. Yeah.
Explain to someone like me the nuances, the differences between Dundee people and Enniskillen people?
Not much, because half Enniskillen was there already.
For once, my generalisation would have been right.
Yes. Okay. Half of Northern Ireland was in Dundee when I was there. So that was a real big attraction. And I’ll tell you a really cracking story. So I was sitting in the restaurant and Dundee on my first night there with my dad not knowing anybody and who walks in through the door. But the guy that I had studied my repeat chemistry A-level with and Dundee Agave remarks live and he bloody walked in and I didn’t know that he was going to Dundee and the two of us lived together for five years. We bought a flat there. We sold the flat and you know, just such a small world. Dundee was a brilliant student city. It’s got a really good campus. It’s real good fun. There’s a really good social life to it. It’s very medical engineering related. They’ve got great facilities. So for me it was like a home from home payment. And on my floor there was 11 or 12 of a seven of us were from Northern Ireland.
And so honestly, I was like driving up the road to Belfast in many ways. So yeah, and the Scots are great. I love the Scots, you know, the old Celtic natures. And so there so it was really I had a really good time in Dundee. Really good time. Yeah. Great fun. Just about got past it but yeah that’s, yeah. It was a good place to be.
Yeah. What we like. As a student, Dental student. What were you like?
Oh, and my my mission was just to pass. Okay. We didn’t want to exhale because exhaling usually took away from the party. So we just wanted to pass. And really, all I wanted to do was finish the five years and get out. I’m not overly academic. You give me something practical to do and show me how to do a practical. That’s the way my body and my brain works. But academia lies. Not really. I did well in orthodontics for me, actually, but then grew to detest. But yeah, I was an okay student. I would have been, you know, if there was a party. I was at the party and, you know, yeah, I left, but I left the good student life. Yeah, I used to drive the night bus because I was good fun. So I used to drive the main bus for the last two years and basically drove around with vomit flying up and down the back of the bus.
Not during the driving Payman.
So I was very well crash, that one was. The buggers were sitting in the back of the bus and there were, I was, there were reverse of me out on the course. I trusted them to reverse me out and I drove straight into a car and so that didn’t go down very well and various investigations have to be followed. But yeah, I drove the bus for two for two years and it was great fun, but that was just to make money, That was just to pay for the car that I’d just bought myself. And that didn’t pass the smell test and I had to sell. But was business always in the blood? Was it was going to happen as a dental student? Did you go into dentistry thinking, knowing.
About business. Always. There was no way I was going to work for anybody. I am totally I am a nightmare. And there’s no way it was ever going to happen, really. But I to give you an example. To give you an example. All right. End on DH. As you come to the end of your your fifth year and you’re getting ready for your vet places, it’s a bit like a bunfight around Scott and Dundee. Everybody’s going for the same practices. So I took a view. Let that classic who move my cheese our book, I took it. Where else can I look here? So I found what’s called the GPT scheme and Bristol. I think it was the first year that ever run and I got in my £250 junior to five with the back wheels up like this. And I drove to Bristol. It was a total death-trap, but I drove to Bristol with two other guys from my class who had identified the same loophole and we went down and we had jobs organised for two years, hospital and practice before any before the jobs were released in Dundee. So basically what happened? All the jobs, or at least everybody went mad, but we had our jobs sorted out and the GPT scheme and Bristol and that gives you an idea maybe how the brain works sometimes. And then I went because I didn’t want to stay there. I wanted to see what there’s more to life than Dundee.
So I then went to Bristol and I had I was really lucky, you know, you meet lucky people or you’re lucky and people that you meet at different times in your life, aren’t you? And I had a first year in vet with a wonderful young dentist called Jordan House, who I owe so much to in Rural Croft and the Practice in Stroud. And this practice, this was 2001. He had a Sarich machine. They did implants. You know, he was a young principal with an old partner. I was sitting at. I was sitting at patients, seeing him place implants, restoring implants all in that first year, doing some private work. In that first year, I had a really experienced nurse. It was brilliant. I had a really good launch pad, whereas a lot of my, my, my compatriots and when they went out, they did not get that launch pad. And then second year in the hospital, baptism of fire, you know, Max, fire department people phoning you up and you’re not having a clue what you’re doing, but you just have to get on with it. And, you know, I just I suppose I just did that. I just got on with and I learnt on the job, you know, the very first clinic I had in hospital, just to think that this actually happened. Sister Jones was her name, a real buxom sister, classic sister with her blue dress on, used to run around like this and go come up.
And you know, I looked about for, you know, I don’t look much older now, but then I looked and so she brought me in and me white coat and she said, This is your first clinic. And it was a sedation clinic. And I goes, But I have never done a van flown on anybody before. I’ve treated somebody who’s sedated, but I’ve never done. She goes, Well, you’ve got five, six patients. It was and it was to take out wisdom. And I said, I don’t have a clue what to do. So she said, That’s okay. We’ll just get you through it. And I remember her standing over me in my hand, the goodness, you know, putting in the first floor. But by God, I learnt, you know, you talk about a learning curve on that job and I loved that job and the consultants were fantastic. I was hungry to learn, I suppose, and I had a bit of chat, which always got me through the difficult situations. And after that I went I had a decision to make which was go home. My wife was also my she wasn’t a wife at that point, but so I knew who I married to. She was with me in England. She was got a job. She was a teacher at that stage. And I had a decision to make, which was, do I come back home? I don’t have a job or do I stay? And really, I was going to have to commit five years back, probably in June and practice.
And we just decided we were going to come home to Fermanagh. And I remember meeting Steve Booth. Steve Booth often tells the story of Steve Booth from Australia and head honcho on stream. And I met him in a pub and I told him what I was going to go back to Ireland. I wanted to use him and implants and that I was going to own the largest implant practice in Ireland. And he still goes, What the hell are you talking about? Bollocks. You know, he obviously doesn’t know what implant from one end to the other. But you know what? I went back to Ireland and we weren’t too far away from that after a couple of years. But, you know, that was the drive. That was what we wanted to do. I went back, worked in a practice, didn’t have a job when I went back. Sonia’s dad, who sold furniture, was down delivering furniture and a dentist house, said a son in law was coming back. He’s a dentist, No job. I should come on shore, Send them down to me. I’ll give them a job. Like no interview, none of that. And I just started the start of putting implants in that practice, redesigned all their brochures and logos, tried to bring them up to the, you know, the 20th century. And after 15 months, lay off and start a album. That was what happened.
James. Seems to me there’s a couple of parallels here between your your chemistry days and at one point you decide you’re going to go for it and then you’re 100% in and dental school. You’re saying you weren’t the type of student who was really interested. And yet two years after dental school, you’re placing implants or whatever, that that’s the kind of person you are that when you decide you’re going to do it, then you finally go and do it, right? Yeah, because when I think back to my own time in dental school, I was like, you didn’t didn’t, didn’t really participate properly. I was just trying to get through. And yet. You know, I didn’t want to do implants like that would be the last person who wanted to cut. What was it? When do you remember a time when you realised I want to be surgeon? Yeah, it’s a big step.
Yeah. That was Paul Stone, actually in university. And Paul Stone, very well known implant dentist, came and we had one lecture and implant dentistry and university. And I remember him coming in and lecture and I can, I could bring you to the spot that he stood in and talking about implants and I remember going, oh that’s, that’s really cool. Imagine just sticking these things and they actually stick the bone like, Holy moly, this is cool. And I do remember at that point, God, if I get out of this place, there’s a future in that thing there that he’s talking about. You know, that’s where the future is. You know, this thing about do and fell into that sounds much more interesting. And so that for me was the first penny that dropped. And then Payman coming out and seeing it done and practice and implants being integrated into normal dentistry, should we say that was a big thing as well. And then the third thing then was building the surgical skills and in the house job, you know, getting that confidence, you know, the confidence, you know, at the time I did that, you’re in theatre, you know, you were working in one half. The growth in the Senior Edge was working on the other half. And, you know, you were just getting exposed to things that you just wouldn’t get exposed to nowadays.
So, you know, my, my learning curve in surgery was really sharp and rapid, but it was done with consultant beside me. And, you know, I’m eternally grateful for that. And I think they seen in me somebody who really wanted to have a goal and wasn’t scared to have a go and wasn’t intimidated by the situation. And I think I took advantage of that because they were quite happy to let me have a go with things I probably I should never have touched. So that really settled for me the surgical side of things. And literally as soon as I landed back in Ireland, I always wanted to place implants, the very first implant I placed. Steve Booth was stand beside me. You know, that was as much of the mentoring that you got. And no, there was no mentoring, you know, it was just do your day, let’s just get on with this. So, so you know, could you get people will do it. No, but it’s so much more restrictive now in terms of how you get started. So, you know, the first thousand implants I placed, I was out knowing, you know, I was just having a go, really.
And James, in terms of in terms of the number of people who could put implants in compared to the number of patients who were up for implant treatment, were you much more in demand back then as a as an implant surgeon or because the market grows, doesn’t it, In both. Both markets grow.
Yeah. You have to remember where I live. So, you know, I live in the west of Ireland, probably the worst dental health anywhere in the UK and in fact could challenge probably most places in Europe. So we have a massive dental caries problem, tooth loss problem. There’s no shortage of work where I live. You know, when we open blew up or, you know, we were doing 300 to 450 implants a year in the back of new. You know, nobody everybody thought Jim Hummel had lost his marbles. What does he do? You know.
You’re right. It wasn’t Manchester or London or whatever.
What we did have been opportunistic. We had cross-border trade. So so we were based right on the border and Northern Ireland. There was a town called Black Lion across the street. So basically I could take a stone and just throw up and I would be in Republic of Ireland. So we had two currencies and we had a trend of people travelling from the south of Ireland to the north of Ireland to get their dentistry. So when we set ourselves up, we took advantage of that. That was a total and utter business decision. And then 2008 hit and the business fell off a cliff because the Celtic Tiger was shot dead. And our job in that time was then to reorganise and remodel the business for the Northern Trade, but also to make the people from the South realise that no, you weren’t coming for value or coming for experience and knowledge and expertise. And, and so we had to pivot and change our message very, very quickly around that 2008 period. And that actually taught us quite a lot of lessons over that stage because a lot of other practices suffered heavily and because the cross border trade dried up.
When you say your message, were you actively marketing back then as well?
I was on the radio. I was doing radio shows. You know, one of it we, Johnny, when he falls and smashes from tooth, you know, what do we do with that? And we were very specific about what we did. You know, Payman Blue Apple. We started out 2005, 2006. And that practice, I look back at that. I was really quite unique at that point. There was very few branded dental practices around. You know, we had a clear idea of what we were doing in terms of what we wanted to deliver, which was a customer service orientated business, not a clinical orientated business, but customer service. And we were six months, six months booked in advance, within a few months of opening the door, you know, it was just mental, mental, and, you know, we weren’t the cheapest. We never set out to be the cheapest we charge what we felt was a reasonable price would be provided, a brilliant service. And that was and that was led by saw my wife. You know, we had we were totally party London, party, London to the hilt, you know, clean toilets, all of those things.
And we just created a really good experience. And we I think at that point where we ahead of the game, I think we probably were. But, you know, the downside of that business then was that it then became something that started Eat US, you know, and we had a great ten years, you know, we absolutely loved our song was raised underneath the reception desk, really, But we had a wonderful time and we met some amazing people. And, you know, those patients come and see me and the clinic and. No, but I sort of distract from your question. The demand is still there because they’re just not that many people to place implants in the west of Ireland. And the numbers are going up all the time. So in terms of the patients who have got a demand for it, and that coupled with the fact that there’s very poor oral health and therefore a lot of adventurous patients, it’s it’s a sort of a it’s a honeypot really to a point. And so.
Within a couple of years, you.
Left that job and then you went to open your the Blue Apple practice and fully box within a short space of time. What were some of the struggles that you had? In Ronin managing. Oh, and in that business, what were the.
What would you consider the low.
Points to be during that journey? Did you hit rock bottom at any point? Yeah, we did. Yeah. Yeah. So we had a real blast. And then two years after we had just won an award, how do you remember? What’s an award that we got? And it was that item from Chris Barrow. And I said, Listen, Chris, we have started this. Our timing has been really good. We’ve done some basics, but we have absolutely no Scooby in terms of how to run dental practice. We didn’t know what accounts were. It was all up, the laughed where we make the money, where we not making money, what are we going to do? And that’s what we started working with Chris. And then he used to come and spend a night in our house every quarter. Listen to us, argue in the morning time and then try and get ourselves back on track. And he was great. I think where the challenge was Prav was that clinical dentistry at that level as challenging, trying to provide that level of service all the time is challenging. And we ran out of steam, but we didn’t. We ran out of steam. Ten years down the line. So I remember the the lowest point. The lowest point was when I went up to Sonya’s office. I sat on the floor and I burst into tears and I said, Fuck where we have to get out of this business.
This is killing us. This is killing us. You know, we the kids, we had two kids. We had the business just eat us alive and try and maintain it at that level. And for me and Sonia and I think less than that level is not acceptable. So, you know, it started to eat us from the inside. And it was at that point I used to go in and, you know, I used to get start to get cross with patients, but not with the patient. That was me. Cross with staff. Why are we getting cross from my staff? My staff are lovely. What am I doing here? And, you know, when you look back on that time, you go the warning signs were there. And at that stage when I went into that chair and I looked and I worked in a beautiful surgery that I had designed myself, you know, most people would go, What are you talking about, James? You’ve got this lovely look. And I go, and I go, If I have to sit in this chair one more fucking day, I’m going to go and see them looking out the same window, looking at the same computer. And that was when I decided to sell it.
It was blown out. James Right.
Yeah. Total burnout. Total burnout, Yeah. When?
When you said it was killing you.
Are you talking.
Family, that work life balance, that dynamic coming home, being pissed off, not being the James or the husband, that you should be the father that you should be? Or was it just all centred at work? Well, try and just just sort of illustrate that to me in terms of what was going on at the time. Yeah. So you were being a rubbish husband, you are giving time to your kids and I was in the middle of doing triathlons and Ironman, you know, cycling from North, the most northerly point in Ireland, the most southerly point cycle. And John O’Groats to Land’s End, you know, you name it, I was stuck in the middle of it. And, you know, all of those things combined just left us in a situation where it’s just not a manageable proposition and we. We at that point, I suppose we even were thinking about expanding the practice. We bought the building next door. You know, it was a nice, profitable business, but it just got to the point where the upside of it didn’t outweigh the downside of it. And that for me was was the point where I said, this business will be sold. Now, Sonia, at that stage wasn’t there in her head. She just wasn’t at that point. But I had been, I suppose, building to that for probably 12 months because I could I stopped enjoying what I was doing. And, you know, that’s not a good place to be when you’re a dentist. And at that point, I could have walked away from clinical dentistry. No bother at all. No bother. And so the process of selling it.
James, did you did you sell it with the ability to walk away or tie in or what was the what was the whole narrative behind that? Because to me, it seems like you want to at this stage hand the keys over, walk away. I’m done. Yeah. So. Yeah. So I was in Dubai and actually Khan O’Brien, who, you know, works with me and introduced me to chop from Oasis, often named Julian. And Julian was looking to purchase a private implant practice and had heard about us. So he said, I’m going to buy your practice. And I said, No, you’re not. He goes, I am. He says, Right, as long as the money’s right, let’s get the deal done. And he came and seen me not long after I was in Dubai. And it took us a year to do the deal. It was a three year earnout. And what’s really you know, they I probably couldn’t have walked away from it. I didn’t want to, I suppose maybe at that stage, because Sonia still wanted to be there for a period of time. I felt bad with staff and all of those things, she said. Less than a three year earnout. And I remember Chris Biro telling me, and probably one of the most accurate things I’ve ever been told. He said, GM is your three year earnout is going to be like you’re running a triathlon. He said the first year is going to be like the swim. You’ll finish, you’ll get out of the water and you’ll go, Oh, that was actually quite nice.
I quite enjoyed that and I am looking forward to getting on to the bike. Second year is like the bike. By the end of the bike you’re ready to get off it and your goal and holy shit, and I have to do the run. And really the third year was horrific, absolutely horrific. I hated every minute of it, but I’m a stubborn bugger and I wasn’t going to stop. And I grew the business. We actually grew the business over those three years despite lots of increased interference. Because basically what I said to them, Prav was you said, I’ll sell you the business, but leave me alone for three years and you’ll get your money and I’ll get my money. But don’t interfere because I know this business and I know how it works. I know how we can continue to generate the high new patient numbers, high value of treatment. We had very high conversion levels, and I know I can do that. And basically I just switched my emails off after about six months and ignored everything that ever came in from them. I didn’t interact with them. I just got on with the job, which was let’s get the patients and less treat them, less, maintain the level of customer service and just keep going that way. And Sonya left after 18 months. She couldn’t stick it anymore. And I always joke with her that she abandoned me in the hour of need. But yeah, so I was left there and we seen it out. And after that it was six months off to recover.
Let’s talk about the highs of that business, too, because sometimes, you know, you talk about burnout, but burnout happens after the sort of the the thing the thing that’s amazing becomes normal. But the acceleration, when you go from opening a practice, not knowing exactly for sure whether it’s going to work or not, and then it works and you’re making loads of money. And give me give me give me some of the best times when what comes to mind when I say the best times of that, that period.
Probably the best times were the relationship with patients. You know, that was old was the thing that gave me the buzz. You know, people talk about, oh, the big reveal. That wasn’t what it was about for me. It was genuinely a patient coming in within 30 minutes. I would have them interviewed to death. They would know everything about them, their families, what their kids did, where they hung out, you know, all of that stuff. And for me it was that relationship building that I really, really enjoyed. And when you’re in a good mindset and a good mainframe, then that’s really easy thing to do. And therefore, I don’t think we ever sold a treatment. It was just listening to the patient and probably one of the pivotal things and it was Larry Brown who we named our centre after Larry Dental technician, probably one of life’s kindest, most generous souls ever. And we still miss him every day. He used to come to my practice and pretty much on a monthly basis, and we used to treat patients together. And that was always the highlight, was when Larry came into the practice and working together with him for the benefit of the patients. It was just such a total pleasure. And we did that for years. Larry used to come to our house. He basically helped us raise our kids. And, you know, he taught me so much about people and life and just being good and getting emotional. No talk of it. But, you know, he was a he was an amazing guy. And when he stopped coming, he just EJ, I think I probably lost a lot of them. Jewel there. Mm hmm.
You know, it’s funny. Those relationships at work sometimes. I mean, that’s a very personal relationship, right? Yeah. So someone. Someone that you were actually next to. But now you’ve been running these distribution businesses, and you’ll find sometimes it’s years and years of relationship with someone from some some supplier. And then this supplier will leave that company, and then you’ll still be in touch with that person and, you know, different person will come along. It’s a beautiful thing. But yeah, obviously this is a bit deeper. You named your practice after him. Wonderful one.
Yeah. Yeah. Larry was a it was a he was a very special man. And actually, it’s, you know, the I think the thing that he taught me more than anything was was the power of empathy. And he used to say one of his great lines was James. When a patient comes in and sits in your chair, they will tell you everything that you need to know. They will tell you their problems, but they will also tell you how to put it right. Now, James, you just need to shut the fuck up and listen. And that’s what he used to say to me. And, you know, just that lesson. He saw he was so right. You know, we as dentists want to get them in the chair and tell them everything that’s wrong with them without listening or not. Very good listeners. And I think you taught the lesson. And just that humility of that type of character was was a very special relationship. So I think, you know, as a high anytime Larry was in the building, it was a hey, the awards, it was a high. So we were we were in for awards at the very start of the awards before the coup. And that was a high hiring. We had a brilliant staff who just loved Blue Apple and everything about it. That was a hey and then treating patients and seeing their families coming in. And a lot of what we did was personal recommendation. It’s the best market I’ve had. Marketing expert as yourself. But for us, that was the best marketing that we did. Without question, price marketing we treated. And I think what we ended up doing was treating patients that we liked and we got the patients that ultimately I hope that we deserved that came into the practice because of the type of experience that we offered. So listen, Payman, don’t get me wrong. No, there were way more highs in that business than there were lows.
Yeah, which is why I ask the question. I don’t want it to sound like it was just not business.
Know, Demonstrate has been very good to us and our business was just 95% of the time. A pleasure to run. It was hard work. It was graft. It was a big risk at the time. I still remember buying the building. I was in the toilet in a restaurant. And so and you had given me a £90,000 limit on the building and it had gone beyond 90. And we were over in England and I was up in the toilet and the estate agent was phoning me and he was saying this 92 and I got, I got 93. And then he came back. And before I goes, I remember looking out the window and seeing Sonja Dean and where she was in a beer garden at the bottom. And I goes back and go for 95 and we got it. And then I have to go down and tell. So I knew we’d got it, but we got it for 95. So yeah, yeah, there’s lots of stories about that business. But yeah, that was good. That was good.
Then he took six months. What did you do?
And. A lot of it was spent on the lake in a boat. Probably drinking too much beer and just spent time. The. De-stressing with the kids, and it was actually a lovely time. My wife at that point, Sonia, hadn’t worked in the business. And then she continued not to work in the business for another three or four years after that. And life was really good, but I got bored and we couldn’t test Dental was still progressing and still going forward. It had moved from that point from being a handpiece repair business, which I told you my dad had decided to do, and a stroke of madness. And we had at that point went on to we were distributing the event and at that stage and just starting and I had just employed Ian and that business was going on. So it was an interest for me. But the brain was working and I was going, What’s this 3D printing thing? All, all of it. And I was quite intrigued by it. But what I couldn’t find in Europe or anywhere at all, for that matter, close by, was somewhere that I could go and find out about 3D printing. So I ended up going to the States to a course run by Auguste Oliveira, and I’m sure you’ve heard of, and that was a printing party.
It was called, I remember. But the reason I went was because all the printing companies were there. And so I wanted in my head I was going printing, distribution, printing, manufacturing. Where could we fit in here? Obviously, understanding that guided surgery, all of those things in my head. So when I went there, it happened to be in Rodanthe Laboratory, which is where crew is manufactured. And after the first day I discovered a table down at the back of the of the lecture room with these metal gate surgical guides. And there was a bit intrigued by the second day I started to become more interested in the guards than it was in the actual printing lectures. And on the day three I got a private tour because I just had the man gaze tortured in the back. So I’ve got a bit of a private tour around the lab. And I remember I still remember the feeling of walking into this lab, you know, almost 200 odd technicians at that point, purpose built building, just mind boggling, mind boggling. And Alan, it was a family run business by the Kawasaki family. And there was a chap called Alan Banks, and Alan showed me around. And I said, Alan, listen, you know, I’m having issues with full artwork that I’ve done.
I can see there’s something in this, what you’re doing, Can I do a kiss? And he said, No. And I said, Why not? And he said, Because we don’t do it out of the USA. I says, Well, that’s stupid. Let let me do a kiss. And he said, No, I don’t think I can. And I said, Well, we need to speak to somebody to try and make this happen. And so the next day was the last day of the course. I went back in and I said, Doll. And again, I hunted them down and I said, Alan, listen, I’ve been really thinking about this. I need to do a case of this. So he says, the only person will make that decision is BJ, who’s the owner of the business. So I then went and got introduced to BJ Koskie, and between him and Alan, they decided that they would let me do a kiss. So at that stage it hadn’t been the people done in Canada and the States that maybe done about 8000 arches. So it was reasonably well dialled in at that point. And I came back and at that stage I set up a peripatetic implant business.
So I went around, set up about eight or nine practices it practising, it was around Ireland where I went and did peripatetic implants because that’s what I thought I was going to do for the foreseeable future. And then one of those practices is in Enniskillen. We did the first groom case outside of the US A. And I did it with my mobile phone beside me and Allen on the mobile phone telling me what to do. So probably not the most scientific way to do this, to do the first kiss, but it was done in two and one half hours. And I thought, you know, there’s some there’s really something in this. So I did a few more cases and kept in contact with the guys in the States. And this was 2018. And then a few more cases got a little bit slicker at it, started to see some of the challenges that it had. And it only at that point, then maybe it was 2019, then it became started to become a commercial conversation. So at that stage we got distribution for a printer called Invasion Tech, which started, of course, three. And in my head it was going to be a digital based business selling Android scanners and printers and all of that.
And had you invested lots of cash at this point? Most of no. Now, how are you getting these these distributions where you like having to buy minimum order quantities and distribute some of that?
It’s called chat.
Just don’t just don’t come see your office. But I promise you.
Tell me this before you go on. Before. Before the story goes on. Explain the difference. What was the difference between this chrome technique and guided surgery?
So what I was doing, which is what most most people do when they unfurl artwork, is that they either don’t plan it, which is what I was pretty much doing, or be the planet analogue. They made it a CT scan, but then they have analogue models. They maybe make an analogue. I’m going to say guide, but there are certain parameters that we initially that we should stick to and we’re doing this type of work. And so the problems that I was seeing were what are called transmission line problems where we have manage the smile zone correctly, breakages of the provisional and the final bridges, because we hadn’t given enough restorative of space and implant positioning, not being very good. So when we combined all of that, plus the fact the difficulty of getting the technician to come to where I was to do the technical work and the length of time. So it was basically a whole day on a practice to do a kiss. So it wasn’t very economical. It was bloody stressful. And we were starting to have problems three or four years down the line. And so it was that that was then putting me off doing any more full arch, immediate work. There was not an issue of the implant sticking to the bone. It wasn’t an issue in terms of demand in the market, but I could see that there was problems there. And so what the system does is basically systemise the record, right from the rector, taking the patient, coming in through the door, right the way to your very final restoration.
Every stage, a system that has a unique system, there is no other system just like it, to basically create this pathway to take you all the way through to the end. And the whole idea is to improve accuracy of implants, to reduce risks, to reduce problems, and to give you increased predictability. That’s pretty much what Chrome does. And that’s then what I started to see from a clinical perspective. So I went back to the States and I said, I want distribution for this. Can I get distribution? No way. Who are you to do distribution for this? And I said, Well, this is my plan. I have a plan mapped out in my head. It’s going to be based around education. We’re going to train people on their teams how to use this product. And I thought, right, I need to get mixes up. So I started getting more and more cases on them about start to get friends to do some cases. So it wasn’t really a commercial entity at that stage. And then in 2000, DA 2020, as we entered into COVID, I had, I suppose, that opportunity to have a conversation with Ken O’Brien, who I knew was leaving as MD of Bayer. And I thought, okay, Mab can be in Northern Ireland. He’s a commercial experience that I don’t have. And a chat again persuaded them to come on board to a business that didn’t really exist.
And so off we went and we he was there for two months. And then COVID hit me up the shop for 12 months. So I still blame him for COVID. So we did that. We had to shut the business and then we started again in 2021. During COVID, we bought the centre because at that point I was you talked about all in earlier on and actually he hit the nail on the head. For me it was all we were doing this or we weren’t doing this. And I decided, in fact, you know, I have a pension, a pension pot there. I reinvested in this building, bought the building, renovated it, and had a vision in my head that this was going to be a digital teaching centre, which is what it is, and that we would close all the businesses and get a lab to manufacture the product. So I suppose I jumped ahead a little bit, but I could see where it was going to go and understanding what was happening in the States where I have very good relationships now. And so we have now done 450 arches in the UK over the last couple of years, and we dominate that gate fully, fully gated market. And we have trained just shy of 150 dentists in our centre on that technique. We have had we’ve just had one of the big UK corporates in our building for a private course.
The fact that we can offer customisation to these big groups is a major push for us this year and because of somebody doing a full arch in Aberdeen and somebody is doing one in London, the process is the same because it’s totally systemised and I know that we can. The bet that we’re good at is the education. I think we’re good at the education. We know how to train people. To give you an example, one of our customers did 52 arches last year, and when he starts racking that into his EBITDA, that’s basically out of £4 million with the value to his practice. So if you do so. So this is a very powerful tool you can on an average and I’m not talking about the clinics, you do a lot of this type of work that’s a slightly different market. But I’m talking to people who do one or two arches a month. You know, we can reduce their chair site time by 66% in terms of the entire process. So I was approached by a practice in London who wants to increase from 12 arches to 52 arches in the year. That’s 40 arches doing a conveyance D that’s 90 chair side is that they have to find 90 chairs. I guess that’s not happening in the busy practice unless you put in more chairs and then you have to find more dentists. But with Chrome you can do it on 30 it. There’s.
So why is it so much quicker, though? Because you don’t have to worry about it. Systemised.
Start-up stage is probably the biggest. So surgical it keeps you on the tracks and surgery on it helps you. I can do most of the cases in about 2 hours from from local anaesthetic to the patient walking out with a provision of bridge. No need for a technician. So the conversion is about ten. That’s what it takes to do the conversion. But the big saving is when you come to do the final bridge, you can do that on two appointments. So you don’t need to go through the four or five steps that most people go through in their final bridge. So you save a lot of time in that final restoration. So for four practices doing this type of work, there is significant savings to be made. So on average, out about £1,000 tier net, I already have come down cruel move or conventional, even though the chrome increases the creases your your front costs a little bit, but not a huge amount.
James I work with quite a.
Few implant surgeons and still yet despite this conversation.
We’ve had. I really want to distil.
Exactly why it is who.
We all work.
The service and the benefits, because the.
Product and the name is popping up everywhere. Whether you go to a trade show, whether you speak to an implant then is to just started using it and it’s blowing his mind or whatever. I guess a lot of these a lot a lot of these dentists who do fall out to implant dentistry, you have to excuse me. I’m not I’m not a dentist and I’m not and I never took an implant in anyone’s head. But the general process that I understand it from from from my perspective is that a patient comes in, they have the consultation, you do the plan. Some people use different implant systems. Some people have like different guided surgery systems. Some people have like a stent made that goes over the over the gums, like drill holes, basically, you know, paint by numbers kind of job, you know, where to sit the drill and it’s going to be safe and the angle and the depth and all of that. And then come to the day you’ve got an on site or a technician on site who’s converting a denture that takes a long time adjustments to that. And then finally they cobble it all together. And after quite a lot of adjusting, they get they fit. The provisional.
Patient goes comes back six.
Months later, three months later or whatever it is. And then then, then they fit the final bridge. What want to wrap my head around is what is your is is it a lab service? Is it a stent? Is it both? Do you produce the provisional and the and the guided thing is talk me through that, knowing what I’ve just said and excuse.
Me if I’ve got any of that detail.
Wrong, but I just want to compare that to to what it is that Chrome does. Yeah. So? So first of all, it’s guided, fully guided search. It’s an open system. It can be used with any implant system that has a gate kit. So that’s the first thing. There’s no limitation in terms of the implant that you use. The very first part of the system is data collection. So we need three elements of data and we call it the tripod of data. These are photographs, CBC, TV impressions, or iOS. So once that so we ask each different type of case, we ask for very slightly different records, but they follow that pattern of that tripod. We then take that information and we do what we call a preliminary evaluation of it. And the reason we do that is because it has to be about the quality of the information going into the system. So if it’s not good, seven out of ten cases stop at that point because the CBC is incorrect. There’s movement in it. There’s bits of a cut-off. The impressions are shit. The iOS is rubbish, the photographs are rubbish. There’s something wrong with the data. So we stop it at that point. And until the data is correct, the case cannot go forward. And that is a learning curve in itself because dentists don’t really like being told that the information that they’ve sent in isn’t good enough.
And that’s just one thing that we have to be open and honest with them about, because what we put in is what we’re going to get out. Guided surgery is computer generated. Although a human is doing it, it still has to be very accurate at the start. So that’s the first step. So we’re systematising the record, taking the second. But then what happens is then it is then goes through internal planning process on planning software and the dentist is called to a planning meeting. And in that planning meeting they sit with the planner and these are dentists, CTS, technicians. Some of them are digital planners. These guys are planning maybe 50 or 60 arches a week. They know their onions. They really understand what’s going on. And what they do is they go totally from their start-ups They say, okay, this is our point. This is where we want our teeth to be. This is our bait. This is our smile. This is transition. This is how much space we need for the type of bridge you’re going to make. And then they work back and place all the implants digitally. And you start as a dentist and you see all of this happening in front of you and you input. Because ultimately, as the dentist, you are having the final say on what happens, but the planner will guide you. So it’s.
Over like a zoom call.
Or. Yeah, yeah, yeah, yeah. So it takes about 40 minutes for your first couple of cases per hour. Once you’re up and running, take time because the planner gets to know what you want. And then from that, then the case comes back to us and an STL files. We then manufacture that in-house. And what we’re manufacturing is a series of stacked surgical gates. So the guy that invented crew owns the patent for stacked and sequential pinned games. So there are two slate, different slate nuances in terms of types of guide, but basically strowman’s mail in the box. He owns the patent that they use. So this guy is a very clever guy. J Watson All right. And basically they’re going to start suing everybody who’s trying to copy them and everybody has to end up in. Now, that’s just the way is. And so what happens then is that the guys are physically we print and manufacture everything in house. We assembly it on or assemble it on models, and then we ship that out. And then that box, you’ve got your provisional bridge, you’ve got all your surgical gates, you’ve got what’s called a surge map, which is a summary of your plan that you stick up on the wall that you can follow. You’ve got maps to organise, your implants, your components, your temporary cylinders. We email the implant company. They know what implants you need to order. They send it out in a box. So basically we’re trying to systemise the planning and the organisation prior to surgery and then you go to surgery and then you follow the process.
Now you get clinical teaching from me. I go to the first case clinically pretty much have been to them all and early in the UK, so that’s a lot of you turn up at the practice. I go to the practice because I want people to have a good experience. What I don’t want people to do is go, Oh, it’s a load of rubbish. It doesn’t work. I know it works because I’ve done nearly 100 cases. All right, I know it works, but you got to follow the system. And if you then follow the system surgically. So what we’re doing is we’re systematising every step of your surgery. And at the end of surgery, you pick up the pre med provisional bridge. Your nurse converts in about 10 minutes. No technician required. You screw it into the marathon and you also. Do what’s called take a copy of that call the rapid appliance, that rapid appliance, and becomes your conversion for your final bridge three months later, which is just two points. So we’re estimating the surgery, we’re estimating your provisional stage, and we’re also estimating your final restoration. That’s what makes it unique. There’s no other system like it. And so what we can do is we can reduce all of your appointments down to about five. From start to finish.
And just a couple of quick questions on that piece.
So the bridge that you produce, does the dentist have choice of material? Aesthetics, fully print. Yet printed printed on on our printers in high speed and invasion tech. I use a print material called Flex era and America. They use car but use a product called Lucid. These products are very similar, but it’s a printed bridge. The final bridge that they get is full arch. Yeah, we do all that for a fixed price of 4995. And that covers everything right through to your final bridge, no matter if you’re placing three implants or seven.
Yeah. Including your final bridge.
So that you on. On, on your end. On your end. How many people did you say you have?
So. Oh. Working. So we have a team across in chorus. We have a team of nine.
That includes the planners.
Most of the planners are still in the States.
Oh, I see.
So we have technicians, we have technicians and admin and this and that for 995. Just just to put.
That into perspective, James.
What would they practice expect to pay? A lab or a lab technician service for that piece? If we’re going to compare apples with apples, which was important. Yeah. Your final bridge. Your final zirconia bridge. Most labs are going to charge you anything between two and a half thousand and £4,000 for a full arch average, possibly plus components. That’s the first part. The second. But to get a technician to see you, you’re probably going to be charged a thousand quid. Yeah, it’s going to be maybe 1200, depending on the job, plus the temporary bridge that they bring with them, which is usually just a denture. So maybe 300 quid plus initial bit of planning in the lab. So the way it works out is that doing a conventionally when you add it all up and go to the final bridge with an average price of about £3,000 for a final bridge is not awfully far away from the crown price. No prices, maybe a bit more. But then if you build in your Ayers chair site, time saving. So an average we’re saving 66.8, then that’s where you start to see your savings. Plus, I’m going to say it, you get your implants in the right place, you’re going to have an easier restoration period. You know, I’ve had technicians in our course. They’re pulling their hair out. These guys are pulling their hair out, solving dental problems. But you’ll get me go and I get a surgery.
But they’re solving dentist problems all the time because most implants that are placed in the UK aren’t in the right place. They’re certainly not in the ideal place. Yeah. Yeah. So as a profession, as a profession, we don’t plan our cases particularly well. And so let’s take Chrome aside for a second and let’s just look at normal gated surgery. Gated surgery has two main advantages. One is that it forces you to plan. That’s a good thing because you have to plan your cases. And secondly, it helps you put the implant in the best possible position for what you’re going to put on at the end. So it forces you to plan with the and and say, you know what, the fine restoration in the mind. And well, if we look if you speak to a lot of technicians, this is a stat that Larry gave me about 15 years ago, 70% of the implants came across his desk and his lab were in the wrong or less than ideal place. Now, I’ve spoken to quite a lot of technicians and they say that that number is not changing as the number of implants are going up. We got to ask ourselves a question as a profession, what are we training? How are we training dentists to put implants? And if that number is not going down. Okay on the way that you get that number two number, Don’t you force people to plan and you force them to use a guard because at least they’re going to be on the play Plain Park.
I remember Larry telling me when I started in 2000 and 3004 with him, GM’s I’m not restoring any of your implants unless you use a surgical gate. Last he told me back then, because he says, I’m not I’m not picking up your shit. Because that’s what technicians do and technicians are to plate. Larry was a great voice for technicians. You know what technicians? Typically what happens is that they’ll get working and they’ll phone the dentist and they’ll say, Well, what do you expect me to do with this? And the dentist will tell them, Do your best. And that’s got to be one of the common phrases between a dentist and a dental technician is do your best. Do your best that are out there managing the complications that exist from poor implant placement. So we’ve got to be realistic as a profession. I would argue quite strongly that what we’re teaching at the minute and implant dentistry, we’re teaching the surgical principles which is lifting flaps and managing soft tissue, all really good, important fundamental things. But the bit we’re missing is to make sure that we put it in the right place. If we put it in the right place, we will reduce our surgical complications and we will reduce our risk of complications. That’s the position. And that’s where guided surgery fits.
Not to mention not to mention that when you know it’s going to go in the right place, you can hand on heart, sell it. You know, you can you can sell it at a higher price. You can when you’re doing this kind of work where it’s full arch, it’s a complicated work. And if if there’s something that’s better that makes it more predictable health or an extra £1,000 or whatever it is, you would 100% do it. Because what I’m interested in is, does this go wrong, too?
I think it’s a really good question. Payment is like anything, you know, does, does and like know guided surgery. The first question I would ask is, does no one guided surgical? I can tell you just told you 70% of them. All right. So, you know, we have there’s this thing. All right? You have to do a guided. A term I really detest. I actually think that’s the illusory truth. Truth? The fact, you know, we say this thing you have to do a brain guided before you do it. Guided. And it’s just become a mantra in dentistry. It’s a load of tosh. All right. People aren’t really thinking when they say that. And I know that that’s a controversial statement, but I really do care because the challenge that I have there is that. Just because you use a gauge, you don’t turn your brain off. That’s a misnomer. That’s number one. Number two, you still have to have the same surgical skills when you use a guide as you do without a guide. It’s still the same fundamentals of surgery. So I’m not advocating flawless guided surgery. That’s a myth. Get it out of your head. All right. I still teach you left to flap. You still see what you’re doing? I’m using this guide to do is put you on the playing field. All right. That’s it. We’re not promising any more. We’re not promising any less. All right.
It’s not a it’s not a magic tool. It’s not a magic tool to avoid the basic surgical skills that you require. But what I see is what happens if something goes wrong during normal non guided surgery. What do you have to do? You have to problem solve. All right. What happens if something goes wrong during a guided surgery protocol? What do you do? You have to problem solve. It’s no different. So one shouldn’t exist in isolation of the other. They actually should both be coming together because there’s massive advantages to both to work together. So we got to stop thinking about these two camps where somebody goes, I’m only doing BrainGate or I’m only doing that, and never the twain should meet. That’s a major mistake in the profession, I think, going forward, because look at the numbers. All right. The numbers tell us that we’re not doing it particularly well. Okay, We’re not getting this right for a large proportion of our patients. And I had a technician on our roadshow who just is a he’s just like, you know, he’s really about to pull his hair out with a stuff because he feels that he can’t say it to the dentist because he doesn’t want to lose a customer. And all the companies are manufacturing weird and wonderful things to try to overcome. Poor implant position. Guys, let’s just put it in the right place to start.
Yeah. What’s the total?
That’s my message.
What’s the total Like that Tam? Total addressable market. How many, how many full arch cases are happening and what percentage of that do you want to get? I mean.
I don’t answer that question as I actually do know Payman. That’s a very hard figure to out because, you know, you can try and pull it out of some of the implant companies, but it’s a challenge. I honestly don’t know what the figure is. So we deal with between 50, probably 50 live cases in our lab every every month. So it’s live at the moment in the States that are probably with between 305 hundred every month. So you have to maybe look at the UK market versus the size of the US market and try and figure out what what the middle ground there is. But I think probably in the UK we could easily double that market without any great stretch. But a could well be bigger than that. I find it a very difficult thing to pinpoint, but one thing we would say is that the large market is growing. You know, again, you only have to look at what the company is concentrating on and also the fact that they’re also concentrated guided surgery. The companies understand this. They’re not so.
And is this not linked at all to stress and near-death? Separate.
Chrome is Chrome. As an individual product, we will use with any implant system that has a gated kit. And to be fair, to be fair to you. Australian and New Zealand actually there really started to click in that. That’s a very powerful product and it’s it’s a product that helps their customers and reduces problems. And they also understand that we that we educate on, I think well, so they are starting to know companies are just implant companies are just some of them are a bit worried about the fact that that I say on the other hand on the other side but I can say on the unit in the UK, you know, Chrome for me is always going to be a bigger market than our market by a long, long way. So our job is not to be a threat to anybody. And I know that Chrome helps sell implants, so implant companies really should see it as a bonus. And you know, the other thing is that the experience here so there’s nearly 18,000 cases done, though, at a mammoth amount of experience that these guys have that sit behind us. And we’re very lucky I call them. It’s like having a back office team. You know, these guys are unbelievable at what they do and there’s new stuff coming out payment all the time. They are a company that are very open to improvements. They’re they’re an open door policy pretty much. You can go and see them and speak to them and that’s something they like and it’s a family run business.
All right. Let’s talk about on this show. We’d like to talk about errors. Clinical errors. What comes to mind when I say clinical errors.
Yeah. So one of the scariest ones that has happened to me was I was doing an implant lower left six on a very nice gentleman from Galway direction was and I dropped the screwdriver and the screwdriver disappeared. And. He started coughing after he had swallowed, I presume did swallow that, I suppose, at that stage. But obviously the fear is that it goes into the right problem because his daughter was a solicitor and as all this happens. So I remember having to set them up, abort the surgery, stitch him up from the hospital and said, listen, you know, this is what’s happened for me locally. And thinking to myself at dinner stomach, you know, this in the stomach, it’s no big problem. And driving them into A&E myself and having a chest X-ray and then a consultant who I knew wagged me over with a big smile on his face, telling me it was on the right bronchus. And here we had a strowman screwdriver. Sharp thing that’s not small lodged in this gentleman’s right bronchus. So he then had to be transferred to Belfast City Hospital in an ambulance, which is about an hour and a half and 45 minutes from here. To get it removed. And I it was a margin and a big scar on his chest getting him to get it out. And I still remember the journey that the next morning driving up to go and see him and see his family, which I’d obviously kept in contact with that evening, thankfully, finding out that he had been able to get it removed and orally. And they’ve been able to fish it out. So that probably for me was one of the scariest things that have happened from a clinical perspective.
What happened, anything after that? Any recourse for no patient?
I’m going to go back to rapport and relationship building. You know, the situation. We handled it as well as we possibly could handle it. We did everything we needed to do. We kept everybody informed. We had a conversation with his family. We explained exactly what was happening.
Things changed. When I say when I say error, I feel like there was no errors in that.
Do you not? Well, I think there was an error because it didn’t have flow. Stayed right in the blood.
Oh, there you go. Good, good, good, good.
You know, and even to this day, sometimes just don’t forget to do it. But yeah, so that. That for me, that was me. I mean, there you have those consequences where somebody have to go to bloody hospital to have a job.
Yeah, yeah, yeah. But error, error errors and when you reflect you think I would have done that differently man. Out the screwdriver. Floss for the scooter. Yeah. Give me one more, man. Cue. One more.
Man. Let me see. Yeah. So another big one was we went through a period of using and the early days of zirconia. So this was actually a really stressful period for myself and Larry. Larry had been involved in some of the early work with streaming under. And so we were doing loads of it and hammered did absolutely loads of it. We were doing large restorations in it and it was all not monolithic at that stage. It was a base with veneered ceramic over the top. And almost every one of them fractured.
And how long after you shooting them?
Probably about 2 to 2 and a half years, even earlier in a lot of instances. So we had and I mean, we had hundreds of these.
Oh, so you suddenly you’re thinking they’re all going to come back.
I’m they they bloody well nearly did. So the hours that I spent cutting zirconia off. And Larry, God bless them, replaced every single one of them. And I don’t think he was ever funded by a Stroman. But we remitted every single case at our expense. I give the clinical time. He gave the technical time. And I remember that period being horrendously stressful. You were waiting for the phone call every day to say, GM’s better. Two beautiful cranes from me and know the fractured. And we were just like, Oh, not another one. And yeah, so I was actually a really horrible.
That’s a biggie.
It was a big that cost a lot of money.
Also, Prav, you have no idea you’re drilling Serco Serco now. Yes. It’s like it just doesn’t. It’s so hard. It’s impossible to get the damn thing off. Yeah.
Yeah. So that when I look back, I tell that story to a lot of people.
That’s one of the worst I’ve heard.
Yeah, that was a really horrible, horrible period. Thanks for that actually pay. Thanks for. You know, I appreciate.
It. We should we should give a medal. A medal, shouldn’t we?
Do I win that award then?
Yeah. You’re definitely in the running for that one, man. What a nightmare. Patient of the patient. And did any of those go? Did anyone like a patient get pissed off or. No, Your rapport. So good. Oh, good, good. Tell us that story.
Good people. Common people. Come on and tell me. You told me this was the best thing since sliced bread. What? Why the hell is it broken? You know, I’m no back. Especially when you had patients that maybe had breakages at different times. So, you know, they had one repair that redid the crown and then you had another one maybe in a few months time, and they started to get annoyed. So.
So did you level with the patients and tell them, look, this is a problem we’re having?
What else did? Of course.
She did. No, it’s a problem we’re having across lots of nations.
It’s a problem. You’re not the only one that’s come in the door with this.
Our. Our. What we are doing as a team is we’re putting them right because we feel there’s an inherent problem with the material. Although we’re handling the material at our site and in the way that we’re told to. We’re still having a fundamental problem. So obviously, it’s like a recall. Yeah, yeah, yeah. I just have to be.
That’s a goodie, James. That’s a goodie. Yeah. I don’t know why I’m taking pleasure from it somehow. It’s another bad story. So you are? My pleasure. Yeah, yeah, yeah, yeah. I think we’re getting to the point where we come to the final questions, guys, But I’ve.
Got one thing that’s that I’ve been thinking a question I’ve been thinking about asking from right at the beginning. James. We were talking about the art of craft that you’re that your father instilled in you. Perhaps what my father instilled in me. And then and then we go on to this situation where we have our own kids and we want to instil the art of craft in them, but we don’t own corner shops anymore, and there’s no newspaper rounds to dish out. But you still want your kids to grow up grounded and understand, depreciate, however you want to put that the value of money or hard work or whatever that that is. Does that ever come up for you?
Look. Look how hard he’s working, dude. I mean, your kid’s going to get it. No, but you as well. You know, I get that. But James worked in the.
Shop, right? That’s where you picked up your. Your personal craft, right? Yeah. Obviously leading by example. Do you ever sit.
Down and have to.
Have those conversations on that piece? What’s your take? Because, you know, both myself and Sonya. And I think that we have we’ve got we have worked fucking hard for. Yeah, we really have. And what’s put a huge amount of pressure on our own personal lives as well as everything else. But, you know, I think that my both myself and Sonya would look back on that and not regret any of it. And when the most of it, I think. But as for I look at Oliver. So Oliver decided that just last week he started his own car, Violet in business, and I caught him outside with a couple of pallets and a screwdriver, making himself a freedom that he can hang all his violet and stuff up on. He created his own Facebook page, and, you know, he he has had a couple of jobs, but they haven’t worked out for him because Oliver is like his father. He’s almost unemployable. And so he has his own cross to bear.
How old is he?
18. Doing a. So. But I look at Oliver. Go on. He went and got himself a job in the local last over the winter time. He went. Then he got his own interview. He did all of that off his own. But now he’s starting this little business cleaning people’s cars. And, you know, so they have always been told, you know, this is what we expect. You know, we work hard. None of this is going to come easy and it shouldn’t come easy to you. Madeline at 16 just isn’t at that stage yet. She just wants to land self over the dog. But she told me she was going to marry a rich man, so maybe that’s her way out of it. I don’t know. But we’ll see.
James So, you know, clearly he’s.
He’s been brought up in an environment in a home where he could be given and have everything he wants. Right? Do you. Do you hold things back? What have you done to instil in him? Go get a job in Asda if you want X, Y and Z or. And I guess the entrepreneurial spirit in him have said, right, I’m going to do my own car cleaning business because that’s a challenge and just talk me. Talk me through that. You know, I look at the kids and they’re so bloody lucky. You know, nice holidays, you know, But. But I think some of it’s a guilt thing for maybe myself and Sonya, because, you know, we probably have sacrificed time with them in the years gone past. And at the minute, things are just so incredibly hectic, you know, in terms of work life balance that is just not right. And we would be the first to admit that. But the kids are not given everything that they want. They have to understand the value of of what they have. And I suppose it’s just a. A persistent reminder of luck to them that things will come easy. But they’re good kids. Lesson, you know, proud of the really, really good kids and they don’t really give us too much trouble. So they’re not being troublesome, really. And they’re pretty good. Also not stood outside the off licence drinking side. That may happen the odd time. Yes. We have had the odd hiccup lesson that the 18 year old boy who plays rugby and has got that sort of circle of friends, you’re going to have the World Cup, of course, but that’s part of it. And I move different teams.
Let’s get let’s get to the final questions. Yeah, I think I think I think you’re going to be we can’t no, no one could listen to your story and not call you a serial entrepreneur. And you’re you know, I read this definition of serial entrepreneur. It’s something like highly optimistic and high pain threshold.
Yeah, we just whitewashed Haven. Yeah.
Just let’s get to the fancy dinner party. Three guests. Dead or alive. Who would you have?
Yeah. So first of all, without a shadow of a doubt as Mr. Larry Brown, Larry would have to be there to have one orderly, one more evening with Larry drinking too much wine, talking rubbish, putting the world to rights would be very special. So I think Larry would have to be there. He’s taught me more than I think anybody else has in my lifetime, bar my own parents. And we have a thing in our businesses where we refer back to Larry on a constant basis. And what would Larry do? You know what how would Larry cope with the situation? And so what they’d do, Larry Brown would be the first person at the table. Second one. This could be an interesting one for some people would have to be Queen Elizabeth. If this is a fantasy table. So our queen, the queen that has just passed away, I would absolutely. I think she was a wonderful woman. And let’s talk about work, work ethic and. Service and all these people go, Oh, well, it was easier. Bloody was not easy. You know, she, she put in some shift and she did it with such dignity. And I know that her and Larry would probably kill one another, which would be even better for them. But yeah, so just being able to have a conversation with her I think would be utterly fascinating. So she would be number two.
That’s a good thing. I’m surprised she hasn’t come up before, you know, That’s a goody.
Yeah. Number three. So I am named after my grandfather. So my dad’s dad and he died. Never met him. He died in his early fifties. As far as I’m aware. And. I’m told that I’m quite like him. I’m told that there’s a sharing of some qualities there. And I think ultimately the entrepreneurial side comes from him. And I would be really interested to know it’s actually a conversation I’ve probably not had with my dad too much. And we have discussed it at times, but not in any great detail. And that’s actually something I need to do, would be to find out a little bit more about what made him tick. I think I’d be quite interested in that and just be in meeting the person you’re named after. I remember I used to do carpet bowls. You guys probably have no idea of Calvados worthy. And it was a big thing. And I was given bowls with Jeff. And there were my granddad bowls when I was about 14. I used to play carpools and. Yeah, So I would like to meet him. So that would be the three. Raising. James, it’s your last day on the planet. You’re surrounded by your kids, the loved ones. And you’ve got to leave them with three pieces of wisdom. Life advice. Call it what you want. What would you say to them? So.
Number one. Something my mother told me when I was about. I reckon I was about 18 or 19. There was an incident that happened amongst my friendship group at the time, and I remember telling me, James, you get shot with the crew as your flavour. And. I’ll never forget her saying that at the time. And really what I’ve taken from that over the years, because I do think about it, is to surround yourself with good people and people that and these people can come and go at different times of your life. You might meet somebody for a short period of time that’s going to have an influence. But surround yourself with people who help you when you need help. Surround yourself with people who are good to you. Surround yourself with people who don’t say yes to you all the time, who can challenge you and help make you a better person. And surround yourself with people better than you. And I think if you do that, I think that that pulls you on as a person and that you learn more and that you’re more reflective and that you’re challenged. And I think that’s important. And the last bit of that one would be don’t suffer fools if there’s somebody in your life that’s taking more from the cup than putting in. Just get rid of them. Just stop.
You know, so I think surround yourself with good people. And I’ve tried to do that. So I think that’s number one. Number two, A is probably the only thing I ever learned in the history class. So there was a phrase or a little poem or whatever put on the wall. I keep on a serving man. They taught me all I knew. Their names are walked by. And when, how and where and who. And I use that all the time. And I think the core of that is to be curious. I want my kids to be curious. I want my staff to be curious. I want them to ask. I want them to challenge. I want them to explore. I do want them to accept the status quo. I want them to be interested in finding things out. That’s always been the way for me. When I put my mind to something, I’ve been curious to find out more. And actually that was also a big part of Larry Brown. And so I think being curious is really, really important and not just to accept things as they are. So that little poem sometimes when I’m presenting something or I’ve got an issue in the business that I want to solve, I’ll go through that. Like, I’ll ask the what, why, where and how you are and who to try to figure it out.
So I think being curious is a really good thing to be. And the third one is definitely have no regrets because I see people living with regret all the time. I see it in my own family at times. And regret just becomes a weight on your shoulders that drags you down. And, you know, we’re here for a relatively short period of time. I don’t want my kids to grow up with any regrets. You know, we have a go. We’ve all got skeletons in the closet. We’ve all had things that don’t work out. But you got to just keep going forward and keep trying. Learn from your mistakes. But you want to be able to look at yourself at the end of the day in the mirror and say, You know what? I give that absolutely my best shot. I can’t ask anything more for myself or for those around me. And you know what? That’s a pretty good place to be. So I do think, you know, let’s get rid of the regret. It’s too harsh. It’s too big a baggage to carry. And there’s no there’s no need for it at all. The people that love you are not sure that you surround yourself with. They don’t want you to live with regret. They just want you to get on with things. So that would be my third.
So beautifully articulated, James. Lovely man. You know, dude, sometimes these you know, we’re 10:00 on a on a monday night. Sometimes you get drained by by these conversations because it’s tiring, Right? But sometimes it’s the opposite. They feed you, wake you up. This one. This one really did that for me. Thank you so much, buddy. Thank you so much. Thanks, JD. In talking to you, we really enjoyed.
That. Thank you both, both of you. I’ve been a fan of the podcast for a while and I love the conversations, but you’ve got to get more people in Ireland onto them. Come on, get the Irish contingent. Tell us, tell us.
Tell us who to have. But you happily send us. Send them over, James.
Send them over. Absolutely. Listen, keep up the good work and thank you very much.
This is Dental Leaders, the podcast where you get to go one on one with emerging leaders in dentistry. Your hosts. Payman, Langroudi and Prav. Solanki.
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