Since leaving Greece in the mid-90s to study dentistry in London, Kostas Karagiannopoulos has carved a name as one of the leading practitioners of injection-moulding composite bonding.
He chats with Payman and Prav about the experimentation and ‘painful mistakes’ that helped him find his way and how a hedonistic year at university almost stopped his career before it started.
In This Episode
04.14 – Injection moulding – indication and limitations
15.23 – Patient communication and technique development
22.23 – USPs and differentiation and techniques
44.09 – Backstory
49.01 – Advice to young dentists
55.25 – NHS
58.30 – Outside the clinic
01.01.40 – Blackbox thinking
01.15.41 – Referrals and organic patients
01.22.58 – The front edge
01.26.43 – Last days and legacy
01.29.47 – Fantasy dinner party
About Kostas Karagiannopoulos
Kostas Karagiannopoulos is a specialist prosthodontist and honorary consultant at King’s College London, where he has taught since 2008.
He is a proponent pioneer of the injection-moulding composite technique, which he teaches through his Prosthoworks training academy.
There’s always new techniques, there’s always new materials. So the way that I plan a case now is different to how I was kind of planning it two years before. I keep seeing changes in the way I speak to people. I keep changing my my consent forms, and I’ve got this 20 years of experience now that I endorse change. I’m not I’m not scared of change. The only limitation is that being an associate, I don’t have a full freedom to kind of open my wings and do whatever I would like. Because if there’s another five people like me, I cannot just be a like a wild card and do whatever I want. But just look for your mistakes, keep training and those change. That’s my message.
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.
It gives me great pleasure to welcome Dr.. Kostas Karagiannopoulos. Dr.. I know that’s what they call you cause there’s your your students love you. Kostas is a prosthodontist who splits his time between private practice in Chelmsford and Saint Albans, and also a consultant at King’s. He’s also part of the famous wonderful Biotinylation group, which I’ve had a lot of lot to do with at its inception. And he’s one of the guys who, when you talk to his students, everyone just loves this teacher. Someone who’s super passionate about his work. And lately he’s gotten into injection moulding of composite injection moulding for all sorts of different cases, both aesthetic and functional cases. Real pleasure to have you. Costas, how are you?
It’s great to join you guys. Thanks for having me. It’s, uh. We’re going to have a good chat and share some opinions. I had a long, clinical day today, but I’m really happy and excited to to to meet up with both of you. I’ve met you on separate occasions, and now it’s. It’s great to be here tonight.
Welcome, Costas. Think what was quite interesting was how we met, because we were both speaking at the same event, and there was a bunch of names that were on this roster of people I was speaking alongside, and Typekit was one of them, so I clearly knew who he was. Then there was you, and I’d never come across you, Costas. And that doesn’t mean a lot, but but then, obviously, I saw you speak, and I’m no clinician, right. So I’m not a judge of clinical work, but I can I can appreciate beautiful teeth and beautiful photography on slides. And I saw that and a very charismatic teacher and then and then pay as you know, I always go to my clinical guy or my point of reference. And I went to pay and I said, so this, this guy’s stuff, is it good? And payments like good. It’s fucking amazing. Prav this, this is the best shit. Right. And so so then I go to Tiff for, for a second, second opinion. Right. And it’s like, this stuff’s amazing. Like, well, why have I heard about all these other injection moulding guys and never heard of this guy, right. You know, I see that as I know you teach and run your own courses. Costas. And I see this as you know, I see this a lot that people who are either really very, very good at what they do and amazing at what they deliver. Not many people have heard of them. Right. And as a marketeer, I find that really, really interesting, really interesting because it’s it’s very, very easy to market something that’s absolutely amazing and harder to to market stuff that’s less so. Right. I guess before we get into your backstory, every Tom, Dick and Harry is doing injection moulding now, right? What’s what’s the deal with that and what’s your point of difference if you don’t mind me putting you on the spot?
Yeah. Good question. It’s it’s something that I get asked a lot because being a registered prosthodontist, it doesn’t automatically go hand in hand with these technique of fully guided composites or copy paste composites. So, um, it started about six years ago. Um, and I got an interest about this through my teaching position at King’s, where I look after the training specialists, and we were struggling to get a predictable result, and it was kind of down to to Bob the builder techniques. And there’s nothing wrong with freehand. It works. Whereas I wanted all my students to, to to put a lot of planning and engineering and architectural work. So I had to kind of think of there’s got to be a way to, to do similar fully guided stuff in the world of composites, similar to implants and ceramics. And I’ve been experimenting and toying with all sorts of techniques. I’ve made every single mistake that there is to make in this technique. And I’d like to consider myself, let’s say, a pioneer, a leader in this technique in this country, although I kind of do a very good job of keeping it a little bit of a secret about. How well I know this technique. So what kind of also gave me the label of the injection moulding guy? Although I tried to get this label off my of my forehead is some webinars that we did withdrew from dentinal tubules of Covid. And after I did that webinar, I got asked a million questions and I got invites for for this and that. And now I’ve ended up having trained about 6700 dentists in Europe and the UK. It’s a very popular technique. It’s a catchy technique. Call it out of laziness, call it out of predictability and consistency. But it has actually transformed my dentistry and it has changed many people’s dentistry.
Of course, that’s one of the sort of indications and limitations when it comes to, you know, whether you’re going to do it with composite or has a prosthodontist. Obviously, traditionally people do it with indirect. What can you tell us about that? Because, you know, the technique hasn’t been around very long.
Yeah. And the materials, the, the by its very nature, the materials have to be sort of flowable or, you know, heated up to become flowable or whatever. Flowable what are the indications were the limitations.
But before I answer, I’ll tell you something that a patient told me this morning. Um, he he had some worn down teeth. He was in his 30s, and he, he kind of did some research that, hey, we can use some composite bondings which are like, say, additive and high maintenance, and they’re going to last about five years, or I’m going to take a little bit of a hit financially, and I’m going to take a little bit of a hit biologically by having my teeth shaved down to some extent and go for porcelain veneers. And I was kind of pushing him a little bit towards the former that, hey, listen buddy, you’re very young. I wouldn’t want to have my teeth shaved down. So I was pushing him for the, let’s say, cheaper option and he was telling me, listen, don’t you want to make triple or quadruple the money from me? I said, I would love to, but I’ve got my kind of ethics, and I’d like to recommend what I would do for my brother. So I’m a little bit biased towards this technique. I love ceramics, I do a lot of ceramics, but I want to give them a chance. So to to answer your question, the main kind of three indications is tooth wear, the worn dentition, um, whether that is erosion from acids, whether that’s kind of attrition or a combination.
The second indication is the kind of the makeovers, the people who come and say, hey, I want composite bondings. And I don’t know where these people where 15 years ago, but now they’re just banging on our door asking for composite bondings. And the third indication is actually as transitional to ceramics as long term temporaries. The technique has been around for, let’s say, 20 years. There was a guy in Alabama, there is a guy, he’s still around, Douglas Terry, who came about with this technique. But the recent advances in material technology have made it a little bit different. So the one of the main questions I get asked is like, hey, how dare you go ahead and put this week kind of Mickey Mouse composite on the incisal edges of your patients. So do I have the published evidence to to to answer back? I don’t all I have is my own experience of five years and several lab studies, some of which have done myself. So this kind of weak flowable is not a weak flowable. It’s performs as well as standard composite paste. Hence, I kind of believe in the benefits of having it flowable because it adapts, but there is no solid evidence. Limitations is the classic things that composites have chipping and discolouration. So average longevity that I give to patients is about five years.
Yeah. But but the limitations of the technique as opposed to the limitations of composite. Oh there are things you can’t do. Oh yes.
That’s what you meant. Well, the things that are not kind of best indications for this technique is like black triangles. You never really going to get a good result with. Technique. Diastema closures are probably better off done with curved matrices and anatomical matrices, and also what most GDPs do up and down the country, which is some form of a line bleach and bonds, where you have to add little corners and small edge bondings, if you will. So this technique is not for small additions, is for big comprehensive plans rather than tiny little corners and additions. These are better off than freehand because you said.
The new materials are the new variables are stronger than they used to be, and I guess they’re more highly filled than they used to be. But what makes the thing flowable if it’s more highly filled than a non flowable and stronger than a non flowable, what? How can it be a flowable?
Yeah, it’s I mean traditionally the floorboards, they had very low filler contents, about 40, 50%. The one that I. Where are you now.
With, with your material 70s. Where are you.
What do you mean where am I? Which brand?
The material that you’re using. Well, you’re using the.
Yeah. My preference is, is the material that kind of dominates this injection moulding technique. It’s called genial universal injectable.
It’s what’s the filler filler.
That’s it’s 6,969%. But it’s not only that. It also has a kind of a silent technology where there’s no big particles and small particles. So so it has a very good ability to to have a gloss retention over time. I haven’t really seen any other material other than the, the, the, the enamel micro that can, can maintain a gloss over time. And the Japanese kind of dominate that market because the main materials are coming from Kuraray, Shofu and JC and I mean, I just finished a lab study at the Eastman where we compared a composite paste, probably the most popular composite paste in the country, and we compared flexural strength and wear, and it came significantly lower than that of the of the JCS injectable. So the material science is there. The material science is there. All that’s lacking is the clinical performance study, which I wish I had the time to do, but I’m struggling for time. If anyone wants to help me, I’d be delighted to to run a study with them.
So but what do you tell patients about longevity then? You say five years.
I tell them exactly what I tell everyone that has composite bondings. I mean, patients are not statisticians. Okay? So the minute you tell somebody that, listen, the average longevity is five years, the way they perceive it is how I would perceive it. If I’m buying a fridge from John Lewis that, hey, I’m going to get a free remake up to the very last day of that five year period. So I go to the extra step and I tell them that, listen, things are going to chip and these repairs are payable, but the frequency and the severity of these chippings means that at about 5 to 7 years, we’re going to need to go for a round two. So I’ve got a very long comprehensive consent form, because what the restorative dentist hates to do is free remakes. It’s a it’s an utter failure. So so people need to know what the rainfall. And as my mentor Frank Speer told me that, hey, would you like your cardiologist to hide anything from you? So I let people know that, hey, we’re not going to shave your teeth. We’re just going to add. But this is not for life.
Must. Let’s go through the process because, you know, obviously we looked at this a lot and I’m sure you went through down a lot of rabbit holes and dead ends and you know, any, any, any sort of development processes like that. And when we looked at it, the number one, the issue with the flow tables, but now you’re telling me you’re happy with the strength and where is the sense of the flow? But the problem that we couldn’t really get over was clean up always with injection and compression. Moulding with clean up was always a big issue. And the sort of air infusion. And as you inject air inclusion, not necessarily by, you know, the teacher but the delegate, you know, that you need to be, I don’t know. We found it very difficult not to include air when we were injecting. You must have had an we gave up right at that point. But you must have had several other hassles and things that you’ve worked through. What I’m trying to go with the question is, you know, being at the tip of something where you’re developing stuff, often you’re making sort of your best guess as to what the right thing to do is of making mistakes and so forth. And it’s in a way, it’s your responsibility as someone at your level. It’s your responsibility to to move things forward. But what how much of that do you share with the patient?
It’s I’ll come back to the patient. Yes. The technique has let’s say the frustration of the delegates is, is the, the cleanup as well as bubble formation. So what I’ve done internally. Yeah. If anything you might get a void subsurface, which in my case happens in about 1 in 15 teeth. So I have different ways to minimise it. We have researched and tried extensively different stents and different vents in order to, to, to start injecting and how you’re going to place your tapes and where you’re going to start, where you’re going to complete. So we teach on our courses several ways to minimise the voids, but you cannot eliminate them. So remember one of my profs at at King’s was was kind of telling me that, listen, injection moulding is great when when you come up with with zero flush then come and speak to me. But but then again when, when any piece of plastic is kind of made with injection moulding, there is always flush. And that is then kind of trimmed up. So the benefit that I have over heated composite paste is that my kind of cleanup is going to be much easier compared to heated paste, because the stent is going to be the stent is going to be the boss. So I’m taking, let’s say, a little bit of a hit by using a weaker composite on the name of rigidity and replication. As far as the voids, yeah. 1 in 15 is going to happen. I look for them, I inspect the restoration, I deal with it. I kind of open it up and repair it on the day using certain lights, but it’s a case of minimising it.
Now as far as the patient is concerned, what patients love about this technique is, is the power of the of the mock up, the test drive, the try before you buy. And I was kind of in in Germany last week and I was telling the delegates that the two best things that I’m at both teaching and executing is the mock up process and temporary crowns, two things that have nothing to do with the final treatment outcome of the patient. So when you kind of want to buy something, you like to try it out, okay, it’s not a free test drive. I charge for this mock ups and the the replication of the design is, in my opinion, much better than using heated composite paste. Why? Because composite paste cools down very quickly, very quickly, and distorts the stent. You’re going to have plenty of excess and you need burrs and disks. I never use any burrs in order to clean up my composites. If I pick up a diamond, that’s an utter failure. So the process kind of almost excites the patient because they they get it that, hey, it’s going to be a copy paste. And I’m not I’m not going to deviate from what I showed them. And that avoids misunderstandings. And when I want to do a little Instagram video to show how excited the patient is, it’s all kind of pretence because the patient knows. From two weeks before exactly what they’re going to get. So so I take a little bit of a hit on the, on the, on the strength of the material in order to win on the predictability.
And I guess you’ve played around with lots of different materials for the stent itself.
Absolutely. The current one that makes a.
Big difference, right?
Oh yes. Listen, the the, um, I don’t hide from the fact that my dental technicians, they make me look super cool because I recreate anatomy that I would struggle to, to create myself. And all I have to do is not make a mistake. So the key to this technique is excellent communication with the lab. You need the top, top, top level of designing. As far as the stent itself is concerned, we now call it the cross the work stent because we’ve spent five years of mistakes of how to, to, to to kind of not to make it. And we have kind of cracked the code. And the way we make our silicone stents now is just awesome. What I also did with my partner Zo from Prostate Works recently because because the emphasis and the onus for this technique is on the designing is is we are designing smiles for dentists. So we are providing a CAD service for, from from prosthodontist to, to dentists.
Oh, sorry. Perhaps ready to geek out, man, but I’ve got.
Look, I’ve got a.
Couple of talks.
I’ve got a couple of questions. Right. Which may seem a little bit too simple. Um, but to be honest, maybe they’re not.
I’m not finished.
You’re not finished yet?
Go on, crack on. Crack on me. Go ahead, go ahead.
So, listen, I spend a lot of my time talking to GP’s, right? And when they come to me for marketing advice, I start quizzing them on their post-graduate education and training they’ve got. And because I’ve got a mark on them. Right. So. So I was asking, you know, if a dentist comes to me and says, hey, I need some implants through the door, I’d say, all right, you need some implants. Tell me about your clinical skills. Are you doing ones and twos? Are you doing full arch? Do you do immediate load, do you do sinus lift, blah blah blah blah. On the composite side of things, what do you know what I mean? Like where do you sit. Yeah. And what training have you done? And all of that’s really important to me as a marketer, because then it helps me to articulate or communicate them in the right way. Right? So in the same respect, I’m sat here now thinking. How the hell do I communicate? The difference between cost us five years of mistakes across the extent. Yeah, to another one. And look, wherever you look on Facebook now, somebody has got an injection moulding course here and an injection moulding course there. And someone else is running this, that and the other. Right. And you’re talking about flash and cleanup and blah blah blah and this, that and the other. Right. What’s the difference? What what is the difference? Like like Costas is telling me his technician makes him look amazing because he recreates anatomy in a way that maybe he couldn’t before. Right. And in my mind, from a simple point of view, what you do is you take a piece of plastic, chuck it in the mouth, get a syringe, throw it in, pull it off, and you’ve got teeth. Yeah, yeah. That’s right.
So some of them, some of them look better. Some of them look better. Some of them are easier to clean up. Some of them are harder to clean up. But you know, I mean, Costas, you’ll know. You’ll know better than all of us how many different ways people are doing it. What I what I understand is there’s this sort of the smile fast way, which is the all the teeth, together with a metal separator unit in it. And then there’s Robbie the way he does it, which is the alternate teeth, which is, I guess, your, your technique as well, alternate teeth, but using normal paste. And then there’s your one which is with flowable. But but from my understanding it’s the aesthetics, the way that the flowable and the stent interact means that you can get more detail, secondary anatomy wise, for the sake of the argument with Costas. Is that right or no.
It is right kind of answer, perhaps. Point. Firstly, we had approached the works. We we hit hard on the quality of the designing, in other words, the communication with the dental technician. So one limitation of training for the last couple of years is that we were training clinicians how to implement the technique, but then it was down to these GP’s to find the right support, the right technician who’s going to speak the same language. And that was a bit of a barrier, because if you have average records, you’re going to get an average design, you’re going to get an average mock-up. This technique has zero capability of improving. The best it can do is replicate. So what differentiates us from, let’s say, our competitors is the extent at which we go to of sending very comprehensive prescriptions, a series of photographs and digital kind of superimposing, which is going to be facially driven in order to customise each and every case rather than having signature. Kind of small, though, that looks like a post-work smile, the way ceramics might look like Luke Barnett ceramics or whatever. So it’s down to to to this bespoke extent. Please repeat your point Payman because I forgot it. I just focussed on perhaps.
Prav ask the question and then I said I think it’s to do with, it’s to do with the way that the material and the technique interacts with the with the stent. So the way it looks is one thing. And then the clean up question, which is the big issue with all of injection moulding, seems to be a bit better with you.
Yeah. It is. Um, again, it was about a month ago. I was in Belgium and a couple of the delegates did a couple of injectables on a type of don’t on the plastic model. And the way that the material came out, it required zero polishing. It was super, super shiny. So they asked me, I’ve been doing composites for 20 years and my composites have never been shiny upon setting the light. So I asked them what was it that polished it? And I can tell you it’s not the material, because if you just use it freehand, it looks matte. Okay. So what it is that polish is it? It’s the super glossy silicone stents. And that is a replica of the super glossy wax up. So the shiny righties, we actually put it on a, on a lathe like a denture in order to, to get a model, which is giving your reflection almost so that you need minimal human touch.
And just like, just like a mylar strip, right? When you put a mylar strip on composite, take it off and it’s super polished.
Absolutely similar to the bio clear injection moulding, because it’s going to be that’s going to hardly need any polishing. So these are things that keep evolving. We keep finding out about new like spinoffs and branches as well as. New indications for this technique? Yeah.
Do you prefer wax up wax ups or digital, or have you taken it fully digital.
For five years? My preference was what I call a hybrid technique of having a printed model, basically of a scan, but physical wax on the printed model. So it was combining the best of both worlds in order to get outstanding anatomy, which required a master ceramist, if you will. But in the last six months or so, the advances of digital libraries are such that we can the anatomy and the the morphology that you can get digitally is par with the one that you can get analogue. So all the cases that we now design are on a exocad the dental software. And we’ve gone fully digital indeed.
Oh, really? Excellent. So is it to do with the resolution of the of the sort of print? Is that what.
The. That is a good point. Typically, as all dentists would have seen printed models, they have these annoying lines on them. The printing lines. Um, so it’s not a true representation of somebody’s teeth. So we have a few ways to, to bypass that and get a model which has zero printing lines. It has to do with the resolution. It has to do with a little bit of manual finishing of the model. And as I said, it’s been five years of painful mistakes where now what we do digitally is as good as we would have done it manually in analogue, but it took five years of of painful mistakes.
Prav. Sorry to keep going. I still don’t.
Think my question’s been. I still don’t think my my question’s been answered.
It looks better from the patient perspective. It looks better.
So you guys said you guys said to me this, right? It’s about how it looks. It’s about the cleanup. Yeah. And the technique or whatever. Right. Alternate to this, that and the other. So I want to know in one sentence. Right. If we take cost as injection moulding we take Robby’s and we take smart. Right. So which one looks the best. Which one’s got the least cleanup and what’s the technique or am I asking a controversial question here?
It’s too controversial for cost.
I you you know, you you know, you both you both don’t know me that well, but you you would have guessed by now that I’m not going to give a direct answer because it’s it’s it’s disrespect to colleagues. If I said mine is better, but all we do is we go to extreme lengths to customise that functional result in aesthetic for that specific patient. So we we do not have, let’s say kind of a signature design. One fits all. And I’m not suggesting this is what my competitors do but but it’s what we do a very high level. And patients will appreciate that because they get to see this on the trial appointment on the, on the on the mock up appointment. And they get involved and it’s about making a bespoke result and a customised result.
I think I have the answer to my question, but I’ve got a follow up question, which is this to deliver this superior end result, does it take more time? Because what I hear marketed about injection moulding is it saves time, right. So now what we’ve got is maybe a copy paste model, and then we’ve got a copy paste model with a layer of bespoke ness over the top, where actually you don’t just have a library and say, we choose this, but but us goes to a to another level in terms of design or whatever, right? That’s what I’m understanding. But does that mean it takes a lot longer to implement in the patient’s mouth as a result of that, or is it a similar time frame?
Very good question. And you’re right. Whatever time you save clinically on the day of execution, because if you do a freehand composite makeover for eight teeth, it might take four hours easily. If you do this, let’s say in the injectable technique, you’re not going to save a lot of time. You’re not going to save a lot of time. It still takes me a good three hours. So what I don’t sell to is, is fast results. What I don’t sell to GDP is the ability to do multiple of these cases. My eyes are completely burned out. I only do one case a day maximum and yes to to. Whatever time you save on the execution is actually spent, not chairside, but on the communication with the lab. So it’s done, let’s say in the evening when you’re sending a very comprehensive prescription to your lab technician. If we receive a wax up prescription, say wax up 3 to 3 with nothing else, we just reject it. So so when we were sending it out to our own labs, it’s like an A4 page with multiple pictures. So a lot of time is invested in the planning. Speaking to your architect about how you want your house and you save some time. Chairside. So dentists love saving chairside time, but there’s a bit more admin time, if you will.
I think the other thing, you know, you talked about the indications and we seem to be focusing on the small make-over indication, but what’s particularly interesting to me is the tooth wear indication becomes a bit more about that because I mean, if it’s erosive, is it different if it’s efficient?
Just to add one more point to, to to to perhaps point before I go into the tooth wear. So just to add one more benefit, is that on a Monday morning, if I get to do some freehand composites and I’m not now comparing to to other injectable techniques, I’m comparing it to freehand. If I if I do it freehand, I’m in a good mood. I didn’t argue with my wife. I might smash the result and it’s going to look stunning. But on a Wednesday afternoon I would have got a text from my wife giving me whatever. A list of things to do or something, and I’m a little bit off. So my composite’s on the Wednesday afternoon are going to look wrong. There’s not going to be consistency. So the injection moulding technique eliminates that element of consistency not eliminates eliminates the mistakes and the lack of consistency. Um so you know what you’re going to get.
You’ve said it. You’ve said it in a very elegant way there, Costas. But but really, the point is, someone like you can do it and do it much better than someone who’s not as experienced. Well, listen. Whereas with whereas with, with injection moulding we really do reduce that variability a lot.
Yes. It’s you can still make mistakes, but you know exactly what you’re going to get from from two weeks before. So it’s it’s not quite a slam dunk, but it’s, it’s pretty close to a slam dunk with a little bit of experience and some training. It requires training this technique, you can’t just go ahead and do it on a Monday morning. It gives you consistency from Monday to Friday. Now to go on to the the tooth wear. It’s it’s a disease let’s say which is much more prevalent. We see it more and more in younger people who have, let’s say a healthy diet and more acidic elements in the diet and more reflux and, and even more eating disorders. So what we know from the tooth wear research is being additive and minimalistic, and small biologic costs is always preferred. So injection moulding and the wound dentition, they just kind of met on a on a on a on a on a Friday night in a bar. And they’re kind of inseparable. So so I don’t know what happened later on that evening. But but the main indication for me is indeed the wound dentition, because that’s the referrals that I get from GP’s and blessed them. A young, inexperienced general dentist, when they see somebody with moderate severe where they don’t even open up the discussion. Why? Because they haven’t really got something tangible to offer. So so they either stay quiet and kind of whistle away, or they kind of send the patient to, to, to a specialist. So you got to change the occlusion. Usually you got to be comprehensive. You got to do extensive number of teeth. And that is a conversation which is very comfortable for me. So I see that longevity and performance of injectable composites for tooth wear perform extremely well. I did cases five six years ago, and the patients are massively thanking me for giving them a lifeline and preventing having to cut their teeth for for crowns and veneers.
Would you say that’s only by referral to a specialist? Or would you say GDP can pull it off as well?
Oh no. Absolutely. Listen, the we set up the injection moulding course, which is a one day course to learn the A to Z of injection moulding and all the questions we were getting, all the questions had to do with tooth wear, palatal erosion, incisal kind of grinding. So a year into prosperworks we had to come up with with a tooth wear course, which is a two day prosthodontic course. And what we tell people is that this is something everyone can do. I would love you to all refer to the specialists, but you don’t need to. It’s something very simple. We go through the chronological journey of a patient in that course, and we promote Glps to actually take on more challenging cases. And the ones that have kind of grasped on the idea, it’s kind of life changing for them because they’re super confident about carrying on complex dentistry that otherwise would need an MSC, if you will. So this is not a specialist territory. I’m never going to protect the the specialists for the management of tooth wear, okay. If it’s massively severe and is missing teeth and there’s TMD, then you probably it might be beyond your leak. But the 90% of the tooth wears are kind of localised, moderate and should be done at primary care level 100%.
What about cost wise cost us? What do you charge compared to.
I’m not cheap, man.
You you remember I was saying earlier that I spend a lot of time on the designing and the the, the. The discussion with the lab. So. So that is reflected on the course. You want me to give you an exact number now for for for per tooth. Exactly.
Well, I can give you an exact number. It’s it’s fine. It’s £550 per tooth. Which, which is not cheap. Okay, but I raise value in this through the process of a mock up, through detailed discussion of the patient being involved in exactly what thereafter. And on the maintenance aspect that. Listen, after we do this, we’re kind of dentally married and you pay me quite a bit of money. Now, everything for one year is guaranteed. Let’s say any repairs are free of charge, but thereafter you have to have an annual maintenance budget. Ceramics are going to be about three times as much. But then again, I’m a little bit biased. Let’s say being a specialist, I might be charging more than the average GDP, so ceramics are going to be at 1500.
Same price on a Monday or a Wednesday.
Absolutely. The only difference is that if I’m doing if you’re okay, you’re joking. And I’m answering seriously, but, but, but but if I’m doing a single teeth at the front, I’m going to be charging more. But, uh, it’s going to be the same on a Monday and a Wednesday. I just want to be consistent. I’ve kind of streamlined the process, and it’s a three step process for the patients. Records mock up execution.
Contact before. Move on to see Prav just itching to get away from this subject because I promised him this podcast wouldn’t be this this way. Listen.
Listen, listen. I’ve been itching to get the injection moulding label off my forehead. And when we’re not, we’re not doing very well here.
But when said, when I say this podcast, I don’t mean this one. I mean the whole podcast. We were supposed to discuss people’s lives instead of teeth, but because I’m geeking out one last final, final question. Do you ever do a layered approach? Do you do a cut back or something?
Oh, absolutely. We’re planning a hands on course in April. I’m bringing a world class clinician from France. We teach layering, but I’m I’m bringing somebody who’s better than me. He’s a guy from France who looks about 15 years old, and he’s amazing at layering. And Celine Higton, my partner in crime with bad emulation. She’s going to join on the day and do something on Rubber Dam. So on a toothpick course. We teach layering in terms of dentine, internal fingers and adding some effects, and then just injecting the facial enamel so that you don’t need the skills of anatomy. So it’s a hybrid technique of whatever we’ve been doing for the last 30 years with palatal silicone case and adding the dentine, but just the very final layer. Instead of going straight, you take a sneaky left and you inject. So this has a lot of future and I don’t want to present this that hey guys, I want you to hold this skill and forget about going to D.D.S. or to Mini Smile Makeover or whatever in order to get the freehand skills. I want people to learn this, but it’s just an auxiliary supplementary technique.
What about cutback? Do you ever cut back and then put another layer of effects or something.
It’s it’s typically we’re going to do it in such a way that we we measure the layers and we just inject. I tried to lay the cutback some three years ago and it was a hassle. It was messy. Plus it wasn’t consistent between teeth, so I gave up on it.
Point. Good point. Let’s move on. Where were you born, buddy? Where were you born?
I was born in Athens. And when was that? 1977. I’m 46. I left exotic Greece in 95, and I moved to something more exotic in Whitechapel to study dentistry in the East End, and I was just telling my dad the other day that I’ve left Greece for 28 years, so it’s a lifetime. I’m never going to go back. But in the summer, Greece is the only place to be, at least for for European standards, because we’re we’re better than Italy and Spain and and Turkey. So I’m as Greek as it gets. Yeah, fine. Fine. Seems fair enough.
Yeah. So you did your undergrad in London Hospital. So you specifically, why didn’t you study in Greece? What was what was the story there?
The the story was that kind of the Greek system required you to memorise a 500 page book and replicate it? There was no kind of critical thinking of any sort. And my older brother had a bit of a bad experience. So so, I mean, I didn’t have an initiative when I was 15, but my dad said, listen, I have a little bit of a background from the UK, so I prepared for the A-levels in Athens. I sat the the A-level exams on the same day as, as all my kind of British peers and surprisingly, I passed. I turned up for some interviews and I don’t know why I chose the Royal London. It was an experience to to be over there before it was massively invested, so it was a bit of a shithole in the late 90s, the university, the university in Whitechapel, now they’ve kind of spent much more money and specialist training. I did it at King’s and the minute I finished I started teaching, which I did for 15 years, and only last week I quit King’s College London, and that’s me done with teaching in a university.
That was, that was that was a run fast, fast run through of your career.
It was it was a little bit.
But tell me, what were you like, were you always very good a no.
No no no absolutely they, they but back in the third year, I remember my dad received a letter that, hey, your son is expelled from the school because of lack of attendance. So, so, so he as a typical Greek dad, he came over here to take control in his hands. And we made an appeal. And we collected all the evidence that I had of attendance. So they let me repeat the year. But then they really pissed me off. And when I get pissed off, I kind of react. So I finished with kind of distinction in the end, but I was super average on the first three years, super average.
And what was the reason for your lack of attendance? Were you partying too hard or.
Oh yeah, partying non-stop. Really? Well, listen, if you leave your family home from a different country and you go into halls of residence where there’s no mum and dad around and Greek, Greek mums and dads, they they just support you financially. You see, there was no student loan or anything for me. I was kind of privileged, let’s say. So I was just partying for three years until they kicked me out. And then I said, okay, now I’ve got to study.
And was the plan always to be a specialist or did that happen? Sort of. The thoughts happen later. I know in Greece there’s a lot of specialists like, you know, the way people think, my Greek friends, every time there’s anything wrong with them, they don’t go to the doctor, they go find a specialist.
It’s yeah, mean in Greece, there’s lots of students, full stop. They all like to study something until they’re 45 years old. But pros came out of frustration from dental school because back at the London it’s now called Queen Mary’s restorative dentistry was very poorly taught, so we didn’t have any decent teachers. And out of frustration that, hey, I don’t get it, I don’t get it. It’s like, how does this fit and how things work? So I said, I’ve got to do a specialist training to understand the subject. Mind you, when I finished the specialist training at King’s, I realised that I know nothing. So I went to several courses in the States to actually learn the business from Frank Spear and Pascal Magnier and and D’ardeche in Geneva. So they were my mentors.
What’s your advice then? When a young guy comes up to you now and says, hey, I want to get really good at fixing problems. Is your advice to follow the path you followed? Or would you say go straight to the spear thing?
No. I tell them to to invest quite a bit of money on a continuum of education through, let’s say, spear education or equivalence rather than the the official specialist training. I know how this is taught in this country if they do want to become specialists. And I’m sorry this if any of my hundreds old trainees are listening to this, I would suggest to actually do the specialist training in a different country. Geneva, like Switzerland or the US. It’s it’s tied up too much to the NHS and it’s not focusing purely on education. So you don’t get value for money by overseas students. They pay £55,000 a year, bless them. And this is the reason why I quit, because we don’t align anymore and I’m all about education. I want to give, give, give. But the trust has its own agenda. Bless them. And they are focusing on numbers.
Yeah I mean look the NHS has been, you know, in Britain they think of it and have like a love hate relationship with the NHS. Right. Because you think like oh it’s there for if you have an emergency medically. But in dentistry I feel like they’ve finally achieved the goal that, you know, the conspiracy theorists used to think they want us to dump it. You know, that’s kind of the way it feels to me. Yeah.
I mean, what I tell young colleagues is, is collect some money, go to the people that inspire you. I mean, I got inspiration from a lecture from Frank spear, who was talking about failure, and I said, wow, if that guy is talking about failure like this, I want to see him talk about success as well. So I spent some, I don’t know, £25,000 on courses in the US. Um, and that’s what I suggest. People, thankfully in the UK is blessed with a plethora of private Dental education. So so mind you, I did most of mine abroad at source rather than through the British Messenger. Um, so I’m a little bit biased.
So I mean, when you say that though, do you not also end up putting yourself as one of those messengers? Are you a messenger?
No, I was about to say. I was about to say I’m I’m the injectable guy at source, so I’m, uh. I’m, uh, I don’t know, I’ve got so much experience with this technique that that I don’t think anybody in this country, the sphere that I’d like to to say so. Yes, in my modest kind of mood. But, um, I’d agree with that. Yeah. I have been a messenger for my mentors, and the simulation group is basically disciples and messengers of the, of the, of the messages of Pascal, Magna and biomimetic dentistry. And I’m leading that team for the UK. Indeed. So but this injectable technique me and so we are kind of spearheading it in the UK.
To date through the population, groups of people who don’t know about it. Because I was a little bit I was completely seduced by it back in the day. And I went I went to a conference in Berlin that it was it was a big event in Berlin back in the day, whenever that was like ten years ago, 15 years ago. And it was the best presentations I’ve ever seen, one after the other. It was it was a crazy thing. I mean, first of all, the AV was just the most extraordinary AV I’ve ever seen in a Dental setting. And then the presentations that Ed McLaren and Panos Basel’s where does it come to now? I haven’t been following it.
Well, it’s it’s formulation is a group of dentists. Let’s say it’s got about 100 members all connected by the drive to preserve dental tissues and avoid aggressive dentistry. And we share kind of ideas and protocols. My contribution is the is the Mickey Mouse injectable technique. And we just came back from a symposium in Bulgaria. There were 500 people and indeed there was 12 presentations, one better after another. What we’re actually planning for the end of next year, we haven’t announced it yet. And probably when this podcast goes live, it’s not going to be common knowledge. But we are planning a London symposium for end of 24, and we’re bringing the creme de la creme of bisimulation to run an international meeting in a very international town in London. And all I have to do is organise it, and I have no clue how to do that. But it’s going to be about education is not going to be about any other kind of agendas. It’s not an academy, it’s not a profit making kind of organisation. And it’s not even, let’s say, a clique or anything. We’re going to open up a pathway for people to enter by simulation through an educational diploma, an educational program. So we’re planning lots of things for the UK with the rest of the team, which is Govinda birth, Celine Higton Zoagli and Claire O’Connor from Ireland. Nice.
Keep me informed, buddy. That sounds so, so exciting. Seven tell. But you did your training at King’s. You could do any private, any practice. General practice at all in the middle of these things. Did you do the NHS? Did you work in the NHS for any period of time?
I did, I did up to the point where the UDR kicked in and I think it was 2004, which is when I started my specialist training and straight after finishing it, I walked for about 15 years in Richmond in, in, in a very good quality private practice, and I was kind of doing GDP work, although I was kind of a specialist. But then at some point I said, listen, I can’t really hide the fact that I’m a specialist anymore. Prav is going to laugh because I’m a pretty good at hiding things. And I started going for specialist jobs and then the training opportunities came. So I’ve been through the item. I’ve been through the NHS, dentistry in hospital. I’ve been through a good private practice of doing kind of GDP work, but now I’m purely limited to to prosthodontics, which is not better, it’s just limited. And I work in two specialist clinics around London, and I’m planning to to move to, to the west and sometime in the new year. Oh, nice. What’s the extent.
Of your work? Do you do implants as well?
Yeah. I mean if anything the, the, the two things that I regret not doing in the past, one is never opening up a business because I don’t know if I opened up one, I would be in the pub by midday. And the second and the second thing that I regret not doing in the past is any serious surgical training. So I kind of see a drop of blood and I start running so I don’t place any implants. I rely on my surgical team either prosthodontist or Periodontists, and I just do the restorative part. So I’m that’s something that I kind of should have done. And I now keep saying to myself, it’s too late, forget about it. I’m not going to open up a business. I’m not going to start placing implants. I’ll just stay in my little comfort zone. But I do a lot of implant work. I do a lot of ceramic work. Although the majority of the cases that I get referred and they come specifically to me because in one clinic I have five prosthodontics and another one seven. They refer these cases specifically for tooth wear and injection moulding. People think that, hey, this might be a good case for for this technique, so I’ll send it to them so that that keeps me busy.
And so that’s what’s a week in the life of of Costas in and outside of dentistry. Right. So we’ve been talking a lot about dentistry today. What about outside of dentistry?
Well, the other thing that I do a lot before I go outside of dentistry is I do a lot of travelling and I go, I’m a key opinion leader for, for Europe. So I do a lot of travelling and I’m trying to stop this and cut, cut down on this. I’ve got a nine year old son, Alexei, who is kind of put a ban on any international travel, any weekend travel, and my hobby and my extracurricular activities is spending time with him. And okay, we do mess around and we do our sporty stuff. That’s that’s what I do. So hobbies are such for my own, for myself. I’m not really going to say that I’ve got anything kind of left. The kind of phased out over the years of of just being a dad and a bringing some money to the house. So whenever I’m not doing any Dental stuff is just focusing on family, but it’s never enough time. So he keeps moaning.
It’s never enough.
And I want and I want him to keep moaning because he’s doing the right thing. Of course.
He is. Us. Um, what would your if your nine year old could pick the perfect day? What would it entail? With you. Obviously.
Like if. Oh, if he, if he could pick like.
You say, you spend some time, not enough time hanging out with him, right? But if he could pick the perfect day with dad, what what would you be doing?
The ideal day would be one where his mum has booked a four hour haircut. God knows what he does for four hours, but something along these lines and then it’s just the two of us. So we’re going to start the day with a little bit of a PlayStation because he’s, let’s say a Covid baby. So so he had a screen time exposure, bless him. Then we’re going to go and play a bit of tennis in the most weird places, like a car park or something random, just completely makeshift kind of tennis. Then go to the local park and tackle me to death playing football. A bit of cycling, just active stuff, which I can just about manage, which I can just about manage as a 46 year old. But I’m I’m feeling the heat already. So. So you Prav you do a lot of kind of activities and you stay healthy. Well, I don’t try my best. So in a couple in a couple of years I’m going to struggle to play football and tennis and all of that with him. But active stuff. Yeah. Awesome.
Let’s get to the darker part of the show.
Yeah. What is your biggest clinical mistake? And I don’t want you to say something like, hey, I picked the wrong patient, but, but, but something when you were in the mouth and you had one of those oh, shit, what have I just done moments.
Um. The first thing that pops to mind is something that stayed with me. I told you about my outstanding surgical skills, and I was kind of taking out an upper six. And of course, the route broke and I was trying to take out the final part of the route, which which kind of completely disappeared on me. I knew that it had gone into a structure called the sinus, which is an empty airspace, because I was pushing that hard that I pushed it into an area that I shouldn’t have, but I was just kind of whistling away in denial that, okay, I can’t see it anymore. So it must have come out and I didn’t really manage it correctly. The poor guy came a week after with a with a swelling, and his sinuses were all over the shop, and I had to kind of send him to Max Fox to have it managed properly. So I learned that you’re never going to get anywhere by just hiding from the problem and kind of whistling away, thinking that it might disappear. So I did it in my own kind of knowledge. I said that it’s never going to come and kick me back, and since then, I’ve just made the change that I would always tell patients what I would like to know rather than please them. Because the minute you try and please someone, it’s always going to come and hit you back. I’m not saying keep them happy, that’s a different thing, but just telling them what they would like to hear.
Trust us. You know, a lot of times, I think you alluded to this when I saw you lecture as well, was you learn from your own mistakes. With patience. Can you think of times where you’ve learned something from the sort of the not from the procedural perspective, but from the sort of human planning perspective? To the patient after seeing them years later when you’ve done something.
Yeah. This is, um, it’s it’s I’ve got a little bit of a disadvantage nowadays because in a clinic where I was for 15 years, I had the merit that I could see how my own work was, was performing, and and now I moved to, to a couple of specialist practices, and I don’t do check-ups. Okay. I do my treatment. I tell people, off you go. If there’s any problems, you’re gonna come back to me. But I’ve, I’ve lost that ability to, to, to see my own work. So I have that limitation as a specialist. So what I do advise young dentists, the majority are going to be GP’s is to, to find your nest, find your base and stay there. Because that constant idea of just being a little butterfly and flying from one position to the other, which is a very typical UK mentality in finance and advertising and whatever doesn’t really work in dentistry, you need that continuity because you. In 2016, you did the best that you could, with the best knowledge that you had and the best skills. But when it comes over years, then, then you’re kind of changing something. Otherwise you would do exactly what you did in 2016. So I’ve lost that kind of merit. And I just see people when there is a problem and I might get an idea, but GDPs have an advantage over that.
But what was the learning point?
What was the learning point that dentistry evolves, although it’s kind of set in stone, and we’re going to be doing a filling the same way that we did it before. There’s always new techniques, there’s always new materials. So the way that I plan a case now is different to how I was kind of planning it two years before. I keep seeing changes in the way I speak to people. I keep changing my my consent forms. And I’ve got this 20 years of experience now that I endorse change. I’m not I’m not scared of change. The only limitation is that being an associate, I don’t have a full freedom to kind of open my wings and do whatever I would like. Because if there’s another five people like me, I cannot just be a like a wild card and do whatever I want. But just look for your mistakes, keep training and those change. That’s my message.
Yeah, but. Sharon. Mistake.
Share a mistake. Other than that.
I mean, you said. You said. You said. You’re absolutely right. Everything you said is absolutely perfect. I really enjoyed everything you said. I used to do veneers when I was a young dentist. I used to veneers and I did stay one place for four years. For only four. Yeah. And four years later my my veneers in approximately stain was occurring. And so I learned from my own mistake there to number one do less veneers because you thinking I’ve done this wonderful beautiful thing. And number two, if you’re going to do veneers, extend it more and approximately so that you know that that interproximal extension of the prep thing. So I learned that by by saying that. Give me an example clinically that, you know, with your level of work and all that that’s going to be I know it’s going to be nuanced, but this example is something where you saw something. Six years later and you thought, I’ve changed. I know you’re doing that every day, right? Give us an example to teach someone.
It’s it’s it’s going to come back to the injectables because I do a lot of them. I’ve done a few, a few hundred cases and it’s got a kind of A22 sides that I do something on day one. And I kind of I inspect it, I look for problems, I try to repair any proximal issues, any little bubbles. And I was kind of looking at something and I said, that’s going to be fine. But but then that patient would, let’s say, come back to me for something irrelevant. And I would say, how what what I knew back then was a small issue, but I kind of ignored it out of laziness, out of whatever that kind of extrapolated into a bigger problem. So I said it before we dentists, we know at least specialists know how things are going to fail. So so don’t hide from that. On a more technical note, it has to do with, again, as you said, wrapping around the wax up as much to the proximal as Pascal Magna calls it the proximal wings in order to hide the junction between tooth and composites. Otherwise you’re going to get that yellow yellow halo. Um, but but more importantly, to, to inspect things thoroughly and whatever you see and it doesn’t quite click with you fix it on the day rather than ignore it because you know that this is going to become a problem. And the patient might not know anything about it, but I don’t care. It’s like it’s my best way to improve so that I do the next case better.
Yeah. No, no. You’re right. I mean, especially with composite. Composite tends to compound like your small area tends to become a much bigger area six years down the line with composite. But you’re right in that, in that the basics of what most people trip up on. And so taking care of the basics, you know, at every step makes a big, big difference.
It’s yeah, it’s it’s it’s you’re thinking that a little void because it’s on the facial. It’s not going to grow into a bigger problem. Well it probably will. And even if the patient is not bothered it’s going to bother me that, hey, I could have managed this better. So the very technically demanding composites, they’re not easy. These composite veneers. And whoever is good at them, I can tell you spends a lot of time on them. Yeah. Do you advocate bleaching.
Them because those.
Bleaching the teeth prior to composite or bleaching the composite itself.
Bleaching the composite.
No, I’ve never I mean I do give trays and gels to people and protective guards. And I tell them, hey, you’re going to need to top it up on your teeth. I’ve never really looked up on the ability of peroxides to to to work on composites. I don’t even know if it works. Yeah, it does.
Not not not as far as changing the colour of the composite, but as far as preventing that little pit from causing dark brown. You know, void. Like looking, looking, looking. Preventing those, those those staining from coming in the first place.
So it slows it down in a way. Okay. Well more enlightened tubes for more, more, more enlightened orders to make them fine. Well, not 100%.
Sure what it does to the composition.
Well, you know.
One night a month.
You know, listen, I’m going to I’m going to give you a better analogy because many people come and tell me, people who have gastric reflux, okay. And they, they, they, they, they, they take omeprazole or whatever that listen, don’t do composites on them. It’s contraindicated because the acid will destroy the composite. And I feel like kind of slapping these people because come on, what’s the alternative? Let’s let’s leave the teeth to rot. You got to intervene. So. So I don’t care what the acid does to composite. I do actually care what the peroxide does if it slows down the staining process. So I’m going to I’m going to give that a go.
It’s the opposite advice that you normally give right. The normal advice is treat the teeth, don’t treat the restorations. But in this case, because composite is so composite is so unforgiving, right. You need to treat the composite to lightly. Let’s get on to career errors. And you alluded to one a minute ago. You said maybe you should have done more surgical training. But what would you say if you could if you could go back 20 years with full knowledge, career wise, what would you what would you which direction would you go or which things wouldn’t you have done and which things would you have done more of?
The. The one that I regret now is not taking the initiative and having the courage to open up my own business. And you may have heard this on several occasions. I always wanted to rely on just doing very good quality dentistry and not having to worry about teeth after 5:00. Well, sadly, I was surprised that I was thinking about teeth after 5:00. But but but not about whether the practice would burn down or whether the nurse would have an, I don’t know, a sick cat the next day and could not come in. So managing people and rotors and managing a shop is was never really something that I wanted to do. But now I kind of pay the price that I’m all my wings are kind of always a little bit kind of dying down, clipped a little bit from that. So I’m kind of, let’s say reaching my, my peak or on the decline, I don’t know. And I would have liked to have the full clinical freedom that this is where I am, this is what I do, come and find me, rather than an associate here or an associate there. So.
You know, dude, what if what if, what if someone said, like Prav said, listen, I’m I’m feeling good. Cost us. I’m going to put some money behind you and perhaps really good on the whole, you know, recruitment rotor part of the thing. And he said, listen, it’s your dream. You do it. What would you do? Like, you know, you don’t have to worry about those bits of it that you hate, right? Which Prav seems to adore.
It’s what would you do? What would you tell us? Your dream like what would be the setup? That was the wings bit that been clipped.
Now I’ll tell you the the wings that I kind of was visioning the 20 years ago would be to have a nice glass facade dental practice on the on the top of a mykonos island cliff, and do a little bit of dentistry and then go to the beach. I’m still working. I’m still. I’m still working on that idea. Um, but yeah, I mean, do you think I want to have three sets of cameras and three sets of equipment and three sets of everything? So I would jump at the opportunity and which I did. Hence, I’m going to make a move into the the West End next year and just have my own base if you will, rather than be all over the shop. Amazing, amazing.
Just just a final question for me is how much of your work is patients coming to you to see you and patients coming to you because they’ve been sent to you by another dentist?
Um, that’s a very good question. So he kind of, um, I had control over that percentage because it was about five years ago that some of my students and my wife, they told me that, listen, you kind of you kind of good at what you do. You should open up some social media channels and promote yourself and blah, blah, blah. So for about 4 or 5 years, I was directing everything towards patients, like simple language, just trying to attract patients into coming and see me. And there was a very healthy influx of inquiries that, hey, I’d like composite bondings and blah, blah, blah. And then I made a kind of a switch that, hey, I’m just going to focus on dentists from now on and not rely on marketing patients directly. So if anything now it’s the referrals from dentists is 90% and 10%, let’s say people off the street contacting directly through my website or through the social media channels. Why? Because I want to have, let’s say, some sort of a filter, that GDP filter that somebody does want to do something about it rather than shopping around. They have the people that were coming through social media channels were just shopping around, or they ended up needing invisaligns. And I’m not the right person for that. So I don’t want to see anyone for a face to face consult that it’s not going to be suitable for me. So my clients, if anything now is.
I guess it makes sense, right? Because they’re all pre-qualified, right? You’re not having to. Essentially, we say in inverted commas, sell to those patients who’ve been sent by a GDP because it’s pre-qualified. Right. Yeah.
That that’s that’s another, let’s say, benefit and advantage that I have that by the time somebody comes to me, they already are hungry for for some treatment, they’re seeking some care and they probably have a budget in their mind. So I don’t have to have the difficult discussion that, oh, I can see a little bit of tooth wear here, or I can see a little bit of crowding. They’ve already been primed. And all I have to do is not make a mistake. So for that reason, let’s say my conversion rates are good. And how does the GDP feel? They’ve got no reason to make my life easier. Or my my my my wallet fatter. They just want to to their patients to be well taken care of. And they know that I will do that. And they don’t want to start a conversation for something that they’re not going to be able to deliver. So I send these patients back rather than poach their patients because I’m not interested in keeping check-ups. So I have zero interest in that. And all I’m looking for is a compliments from that GDP after a year or two. That’s wow. That that work that you did for X, Y and Z or whatever was stunning. And that is the best advert for me. So that I keep referring patients to me.
Because that’s as far as the sort of timing of your life. It seems like you’re mostly in practice, right? And then teaching is a smaller part of it, but if you could have it your way, would you teach more and practice less?
Um. Clinical practice and dealing with patients is stressful. There’s no dentist that that is going to say otherwise. I was in Israel, and I remember one of the profs over there was telling me that, listen, the minute you stop the clinical practice, you’ve got two years of teaching, then you’re dead. And I was like, no, come on, man. It’s it’s it can’t be true. He says, you’re going to be presenting the same cases again and again. You’re just going to be providing microwave foods. So. So don’t disturb that balance too much. So I’m doing more and more teaching through Prosperworks and JC kind of Europe and by emulation in the new year. Um, but I have zero intention of reducing the clinical activity, both because it excites me, both because it feeds new cases and new potential techniques that that I can do. And yeah, if I did stop the clinical work, I would just phase out. I would I don’t know that that guy was probably right. I would just teach for a few more years and then I would get out of date kind of thing.
Also, I think it’s your hobby, dude. You know, and you said you haven’t got a hobby. You got a hobby, your hobbies.
Teeth and photography and photography. Unfortunately. Um, so, yeah, I mean, it’s it’s. Listen, if I get a WhatsApp message about a clinical case, I will always reply. Always. So I do have a big passion for what I do when I teach. I give giving everything I have, which I did at King’s for 15 years. I don’t know how long that drive is going to carry on for, but while it does, I’m just expanding my educational horizons to, to, to to to provide the best I can, which is why I left King’s.
Think, think. Jesse Gulati, a good friend of Prav, said on one of his pods that the you know, the biomimetic guys in dentistry seem to be the happiest ones. And I wouldn’t put you in that in that box because you’re much more than a biomimetic guy. But but they are happy dentists, man. The real the real geeks.
I thought you was about to say you don’t put him in the happy box.
I wouldn’t put him only in that box. He’s a bit more than just a Payman. Yeah.
I mean, yeah, I don’t really I don’t really do single tooth dentistry is is the cases that I do and I’m not presenting myself as better or whatever is my, my default. My default is is looking at the global picture is not single tooth dentistry. But I admire these people that spend a lot of time and science and thinking on doing one simple teeth, one simple thing to the highest precision and excellence. And I want, I want people like that around me.
Yeah, yeah, yeah. Um, let’s get to the. I’ve got. I do have one other interest though, dude. Yeah, that, you know, the problem solving part of it, the development part of it. Do you trace that back to something in your sort of like, you know, you said, oh, the first three years you were partying in dental school, you weren’t really trying to excel. Then you excelled. Just excelling piece being really good and being at the, you know, at the front edge of something. When did that come from?
That’s a good question. It might actually be instilled in most dentists. Although I have seen some who couldn’t care less. But let’s say the average dentist who goes onto courses and likes what they do is a little bit of a perfectionist. Where did that come from? Um, probably from my A-level years, where I was kind of prepping for A-level chemistry and physics and maths, and it was completely different to what I was doing 9 to 5 in the Greek school. And um, bizarrely enough, I was kind of keen to go back home and open up. I remember the book was called Ramsden’s. It was like A-level chemistry and do exercises and solve the problems. So I was seeing it as a, as a, as a hobby, like, like, I don’t know, just eating peanuts, you know, when you can’t stop. So that that is kind of probably where it started. But then I had a three year sabbatical of partying till five in the morning as a junior uni student, and then I went back into my geekiness and I said, okay, let’s let’s put some effort into this and okay. Then the pros side kind of came and I had the special interest for this. So it probably goes back to the A-level years. Yeah.
I mean most teenagers would like to, to to to just go and flirt with a lot of girls. I was just doing chemistry kind of equations, but hey ho, um.
I didn’t, I did, I.
Didn’t the parting a little bit late though. In Whitechapel. It’s okay.
Yeah, it was the same. Was the same but. And Prav Prav it was the Oxford, Oxford medic. There was some of that in years. Oh, Prav.
There was the first year I hung out with the English students and the historians, who had literally no work to do, virtually no lectures, and I was just blind drunk six nights a week, and everyone thought, this kid’s going to fail. Literally. Yeah. But then I think it’s like Costas says, right? When the crunch comes to the crunch, you kind of think, right, I’ve got to pull my socks up now and get my shit together and look for Costas. It took a visit from his dad, right, and whatnot. And for me, that’s it. I had the fear of my dad from Manchester, like, always coursing through my veins. Right. So either way, it was there was still a family influence to pull your socks up and get on with it. But I’ve always been a crammer as well. Right. So last minute you pull all the stops out, right? All or nothing. And onto our onto our final question. Costa. So imagine it’s Costas. It’s your last day on the planet. You’re surrounded by your loved ones, your boy, and you have to leave three parting bits of wisdom. Life advice. Call it what you want. What would they be?
The first thing is something that comes to mind, and it’s probably something I’m going to poorly translate from Greek, is that it’s best to kind of have a regret about something rather than say to yourself, how would it be if I did that? There’s probably an expression in English that, that that says that, but that bypasses me now. But you know, what I mean is that sense of like, not not having the cojones to do something and always be, oh, I didn’t I never really did that. And how would it feel? It’s, it’s I would just tell my son that, listen.
Go for it.
Go, go with what kind of clicks for you and see where it takes you. Because if it’s I mean, for me, I used to love, I don’t know, music and DJing and I wanted to be the DJ of a ministry of sound. Thankfully, I didn’t pursue that because I would be rubbish at it. Um, but I would just say to him that and it goes into the second point, that whatever makes your heart race, it’s going to become your, your hobby. So so, so, so go with that. And if you’re good at it, that’s let’s say the money will come. Now a typical Indian dad or Greek dad would, would, would never really agree with this that, hey, you got to be an accountant or a doctor. But the third thing is that, I mean, if he’s I hope it doesn’t happen in the next year, because if he’s ten years old, he would really understand that. When you do love someone, love them with a passion and give 100% of what you have because it’s going to be the biggest investment you can possibly do to show your emotions and your love to your other half. So that’s the three things.
That question is so interesting because that question could could either be, look, I’ve done this in my life, so I’m telling you, or it could be the exact opposite. It could be that I’ve not done that in my life, but I want you to. Yeah. Of course. It’s such an interesting question. Of course, but mine isn’t as interesting. Fantasy dinner party where you can have three guests ready. Dead or alive. Which three guests would you have? Who do you want to have?
I can easily think of two out of three, and they come from the entertainment industry, and they are people that I never got a chance to see live on stage. One is Freddie Mercury for his magical voice. It was like borderline. I said, oh, early 90s. I was kind of a young teenager. I could have just make it happen, but I was a few years late. The second one would be because I love my kind of house music and dancing would be to, to, to, to to see Michael Jackson perform. And who is the, the godfather of of of of dancing because he was training 6 or 7 hours a day just dancing. I mean, who would possibly do that? The third person I don’t know, I don’t know, um, somebody like Prav who, who, who has the discipline to, to to say to himself or herself that, listen, I’m going to wake up at five, I’m going to suffer in on the name of my kind of physical health and subsequently mental, then go to the gym and, and follow the old ancient Greek kind of saying that healthy mind in a healthy body. And that motivation is something that I’m struggling to find in the UK, where it’s kind of gloomy and miserable and say, like, sod it, I’m just going to have have, have a fry up or something. So it’s not somebody specific, but, but somebody who could.
Present a good idea and perhaps a good idea. Don’t get me wrong.
Well, I have this I.
Have this mental image of him like the, the.
The, the, the.
Freddie Mercury, Michael Jackson.
And Prav Solanki.
Yeah. See? Robin. Yeah.
No no no.
The interesting interesting. He says that. Right. So about 4:45 this morning. I get into an ice bath that’s two degrees C and I sit in there. Exactly.
All that shit.
I sit in there for four minutes, freezing my stones off and then spend the next 30 minutes shivering. Yeah. Yeah. Contemplating. What the fuck am I doing with myself? Yeah. And convincing myself this is good for me. Yeah. Um. And it’s dark and it’s miserable and it’s horrible. So I get it. And but but do you know what?
When you feel great for three hours. No.
Feel amazing for the rest of the day. But. But the thing is, I’ve been on the complete opposite end of that spectrum, right? You know that more than anyone else. Payman. Right where I’m literally in self-destruct mode, and I’ll wake up in the morning and make myself cheese on toast, you know, or or actually, I had pizza the night before, so I don’t even have to make myself cheese on toast.
So there you go. That’s probably the worst trio you’ve ever come across in the podcast. Michael, Michael Jackson, Freddy and somebody like Prav. But anyway, there you go.
What about what about if you could sit with a few dentists? Who are you like your dentist you want to sit with?
Which dentists do I want to do? What with?
Oh, um. Hula. Hula. That would be my my, my my three mentors. Um, and unfortunately, the kind of life brought it that they’re all kind of males. And that would be Frank Speer, Pascal Mani and Did.she because I don’t know, they’ve got so much to give. They are the best educators I’ve ever come across, and they can kind of educate in one minute. What it takes me about a fortnight, okay. Over dinner we wouldn’t quite talk procedures and stuff, but these have been the people that inspire me. So I’m kind of always looked outside of the UK. So it’s it’s not quite UK names.
I just saw um, nazzari in BCD water presentation, but I was really impressed with that.
Yeah, well, next year you’re going to be massively disappointed with the BCD Line-Up of Jaz Gulati, K.K. and Mahmud. So. So it’s going to be a bit of a letdown, but hey ho.
How you doing that up, buddy? Lovely. Lovely to have you back. Thank you. Really lovely to have you. Really enjoyed that very much. Thank you so much for sharing so, so openly.
I think if we’ve achieved.
Anything otherwise, if.
We’ve achieved anything today cost us is maybe that, um, world’s best kept secret that you are is is probably not so much of a secret anymore when we publish this. Right. And more people find out about you.
Thank you. Thank you for the opportunity. It was it was great to chat and it was really a joy indeed. I really mean that.
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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