[00:00:05] This is Dental Leaders, the podcast where you get to go one on one with emerging Leaders and Dental Street. Your heist’s Payman Langroudi, I’m Prav Solanki

[00:00:22] This week on Dental Leaders, we’re bringing you some of the best implant industry content that we’ve recorded over the last couple of years from our implant Leaders those dentists who’ve got an expertise in implant dentistry and who share some hints, tips and advice and nuggets around the topic of implant dentistry. Some of the people who we’ve had the pleasure of interviewing include dear friends, colleagues and clients of mine and others who I’ve just met during this process of recording the Dental Leaders podcast, The Implant Leaders that you Bohem from include the Italian cooler than cool Alfonso Rao, who I’ve had the pleasure of working with for many, many years. And Alfonso, how did the teaching come about? Because I remember when we first met, we were having our initial discussions were around, hey, I’ve got this company who want me to teach for them. I’ve got this company. You want me to teach for the this one wants to give me this, wants to give me why, etc., etc.. I remember those conversations so vividly. And so how did you from coming from Italy to hear being as young as you are, how did you get yourself recognised as Hey, I can teach or I want to teach or what was what was your teaching journey? I mean, that is something that I always really, really liked my since my time at university. I think that everything you say this obviously is completely correct is not something it is being taught like a lot of things not I’m not extremely good seeking a business plan and say this is going to happen now.

[00:01:56] This is going to happen next. I do a lot of things as I feel that are right for me, for my colleagues, for my practise and for my family. So a lot was that I was invited to teach for different companies in a different aspect. Now, at that point, I start to feel that that was not enough because I was doing things for others, but for myself, and I think especially when you’re the teaching is extremely important to be as independent as possible. Obviously, I do work with a lot of company and I do a relationship with them as well. I wouldn’t have. Show or discuss them, of course, something that I honestly don’t really use in my clinical work every day, because there is obviously dignity and ethics. I don’t think that otherwise I would be greeted as by Anita. So that is the reason, because we started to say, OK, but then for the people teaching for company, well, the only person you knew that why I’m not having my academy, I’m happy to deal with a company that I usually work with my clinical staff anyway. But in basically in my way, in my role in my time, and I’ll decide how to do it. But teaching is something that I find extremely rewarding from a clinical point of view, I find it that helped me to be a dentist because, you know, since I remember this was a conversation where the beginning at the beginning, I was not taking orders. But now I do photos of almost every cases because obviously, I mean for the teacher.

[00:03:34] And then when I review my photos, because I have to prepare an actual presentation, I often try to be self-critical. And I should have done this in a different way. I should have done this in a different way. And I’m not too competitive with the people around me. And I was thinking you weeks to write. I’m really relaxed about my competition and my competitors, but they’re not competitive with myself. So, you know, I always want more from me. And what you guys did with the implant ology and Massimo does is all right. Yes. So I do all the implants. I must admit an OK. But then we also used our Italian connexion the last few years to do like some prosthetics or or restorative course we like from rubber dam surgery, from dippie to for large cases. So microsurgery. So we always try to do a course with a different level. But one of the nice things that works is keep the academy is that nice and fun place to be. And so we realise that a lot of people are coming to the academy, of course, and then they’ll end up in the home with us. Andrew Daywalt, who has got this supercenter in London and is operating at the very pinnacle and cutting edge of implant dentistry. And in terms of being one of the leading implant clinics in the UK, in terms of pricing and level of investment, where do you sit? I’m assuming at the top end of the

[00:05:06] Line we are an absolute bargain. No, no, I’m I’m actually being all of that completely serious love that. I’m being completely serious. So we OK, look, you’re talking about us as an implant clinic and actually we’re not an implant clinic. We’re a specialist practise. We’re a practise with many specialists in it. Actually, we’re not all specialists, but we’re a practise where if it is appropriate that a patient has a feeling, they’ll have a feeling, if it’s appropriate that they’ll have a difficult reconstruction on teeth. And that’s what they’re going to have. Yes, I do implants almost exclusively implants. But it’s, you know, what is an implant clinic? I mean, maybe that shouldn’t really be there. I don’t think a specialist implant, you know, we talk about should there be a specialism and implant dentistry? I don’t really think there should be because it’s actually about restoring dentistry and we need that overall perspective. So we are about coming back to a point. I mean, we’re a bargain because we’re hyper efficient. I think we’re extremely efficient at what we do. We’ve been doing it a very long time. We use known, highly regarded implant systems and we do that from from the ground up. So we are implant system is something that’s highly regarded and well known. But the components that we put on top of it are also of that system. So I think something that people don’t really get is that what you put on top of the implants is as important as the implants. And a lot of patients will say, well, I had to you know, they used that implant. It’s a really good implant.

[00:06:57] But then you see that what’s been put on it just doesn’t fit at all. And they’ve used, you know, cheap stuff, cheap stuff on top. And that’s a great way to cause implant itis, for example. So the implant fails because of the restorative work that’s done. So when we work with referrers, we work very closely with them to make sure that what goes on the implant is the right thing. Now, if you’re going to do it right, it is going to cost a bit more. I think I’m actually going to name some thing that’s happening at the moment because we hear you laughing. I think you know what I’m going to tell you. So this is a Dental company called Finest Dental, which is just recently, I understand, going bankrupt or something like that. And there were patients out there who have just been left in the most appalling state and some of them have found their way to our practise. And it’s just just mind boggling. I mean, they have had implants provided from a from a well known manufacturer. But of the patients, I’ve seen the implants look like being shot in, um, the far more of them than they should be from the implants. So they’re paid very little. I believe the. Very little, but for twice as many implants as they needed, then what’s being put on top just beggars belief. The thought to the collusion, no thought to the opposing arch thoughts of the Dental state, the restorative state. And I mean, it’s it’s worrying. It’s upsetting because it gives us all a bad name.

[00:08:38] Dr Andrew Moore, who I’ve had the pleasure of working with for well over a decade, one of the nicest guys in dentistry and omes, shall we say, dead on, because he recently exited the mall, one of the most beautiful practises I’ve ever stepped foot in with an amazing patient experience in an atmosphere that you’ve just got to experience to pick it up. I always said to Andrew, if he could bottle of what he’s created at his clinic and disallow that into other clinics, he’d make a lot more money than he would place in implants.

[00:09:13] Yeah, I used to do a lot of surgery when I first qualified, I used to work at the hospital and do there was a days when you were there were there was a department run by one consultant and sideshow in about eight clinical assistants. And someone got me into doing that when I first qualified. So I still like doing you know, we used to run our own less. It was really good. It was great way again, surgical, you know, sort of experience. And then after probably I think it was about seven or eight years of the NHS, did a lot of amalgams in a really busy, busy NHS practise, just like I just don’t know if I could do this for the rest of my life, you know, and started then looking around for other things. And someone said to me, oh, you should look at implants. Who could be the next big thing? So I, I met Ashok’s at the AU and I did Ashok’s course and I’ve got a lot of to Ashok for because he opened my eyes to to things dentistry could be you know, I remember going to practise in Harley Street is a big town house in Hollister. And again, this is amazing. This is why one, this is what I want to do.

[00:10:25] What sort of stage career were you were

[00:10:27] That I was in that transition where I’d been where dentistry was. It was getting to be the same old, same old. How many years qualified were you by then. So must have been eight, maybe nine years qualified. And I was just, I was still enjoying er I was still enjoying dentistry but I was just at that point of like oh my God, I could be doing this for another five years. I to do something else, not something else you know, because I now I’ve got limitations by something, maybe a just a different challenge. So that was good for me to, to go and see what else was going out there. And then I started going on courses through Asharq, you know, did he did his year course and and I thought to myself, well, I’ll do the odd implant here and there and and again, have quite a leap of faith as an associate in a predominantly NHS practise to turn around and go, oh, I’m going to buy all the implant stuff and physio dispenser that care all that, you know, and all this when you

[00:11:28] Are you placing all 750 implants were sold for a second implant all

[00:11:33] Up until recently. I was. Yeah, but Phil is now doing a lot of yeah. He’s doing a lot of stuff so. Yeah. I mean he’s good. I mean we’ve got so many patients who just because I think been in the same street, I’ve worked in the same street for 30 years. So we’ve got a lot of patients out there and I walk through town. Yeah. Yeah. So they’re just these is a volume of people. I don’t remember the name. I remember what I did on them. And then they, they sort of you get people coming out the blue. I saw some on the yesterday and he was who hadn’t seen for 15 years. Wow. And just came in said ah broken to the did an implant for me fifteen years ago and I just want that one out and you know, so I get people just coming back so it gets easier. I think as you’ve done more there’s, there’s not much selling involved for me anymore with implants because a lot people are sold on it. And I like the old days. It was a real leap of faith for people, you know,

[00:12:35] And we’ve got Anil Shrestha, who I consider to be the true gentleman of dentistry. Whenever a media company he is always acts, dresses and articulates himself as a true gentleman. And he’s got some really interesting nuggets to share in this episode.

[00:12:53] If you had to see your work in percentage terms, how much of it is implant ology, how much of it is straight aesthetic dentistry, how much of it is restorative rehab type stuff? I know, I know it’s all mixed together as well as cases,

[00:13:08] But that’s a good question as well. So last year, because I audit every week and at the end of every year, etc., So like last year I started in nineteen full mouth rehabs. That’s enough to keep me working for at least another year. In fact, you’ve been to the practise. You’ve seen my list of actually that’s enough to keep me working for another two, three years. And I get new patients with stuff like that. I have to pick and choose very carefully. I teach at the Royal London. I teach on the prosthodontics specialist training programme as one of their clinical tutors. And I say to these guys, listen, you really need to learn all of the academic stuff as well as the clinical stuff and clinics very well. But what you learn to be able to work like people like me being able to rebuild a whole mouth, reconstruct them, not just a.. Case is not just beautiful, perhaps, but rebuilding a whole mouth and reorganising inclusions, including doing the grafting and the implants, which is the majority of my work. And restorative implants. It’s only 50 percent of what you actually need to master.

[00:14:10] The other 50 percent is. Being able to be empathetic and looking after these patients, because I have patients who have certified post-traumatic stress disorder, several of them, I have patients who are incredibly difficult to manage, who you just have to understand them. You have to be empathetic, but you also have to be in command. I have patients who have walked out the door who had so much trauma that they become alcoholics from from the previous traumas they’ve had. I’ve had a patient who I had to section because she she literally left and she was so emotional, revisited past traumas that police had to take her into their custody of 50 percent of that work is not actually clinical dentistry. It’s the management of the patients. And I think that reflects what Michael was saying. You know, his patients were not easy. He used to pick and choose his patients. I’ve heard it said that he used to say Leaders said to me his practise was based not on the patients. He used to treat the very famous ones, etc., but the patients he didn’t treat because he knew how to select them.

[00:15:13] Yeah, well, I was going to ask you that question said in your position, you must come across a bunch of people who their problem is more. Let’s call it psychological than than

[00:15:23] I’d say it forms a significant part.

[00:15:26] Then we’ve got Basil Mizrachi, who to many is known as one of the top, not just implants, is one of the top dentists in the world and even himself coming back with some of his shortcomings and mistakes and paralysed by perfectionism during his episode, I found really interesting. What would you say are a few things that most dentists don’t know or get wrong that you wish that they got right and they thought more about it? Was it that what you just said? I zoomed out thought process. I mean, even examples now for our composite course, I wish more dentists paid more attention to primary anatomy now before I mean, we try and put that into their heads when when they get there. But they’ll come in talking about layering and colour and secondary anatomy. But but not to have focussed enough on primary anatomy, simple things or polishing, finishing and polishing, for instance, everyone’s got their head into colour for some reason. And so in bleaching something I wish people gave a damn about their impression of as much as they keep pretending to know what they’re talking about when it comes to percentages of gels. Yeah, everyone goes into that. It is always the first question. The percentage gels that bit. But I wish more people took better impressions in your world. So I wish people paid more attention to the temptress. So of course, because I think, guys, that’s stuff that allows to go from single to suit to multiple dates.

[00:17:06] So I think that is the key to success when you want to start doing more complex. And I don’t think they just realise that when they come out of Dental school and then they try the limited knowledge of how to do it. And we are stable when you try to do more complex as a patient or even what, temporaries the food, right? Yeah. Your temper is the kind of functional thing, isn’t it? It’s not just not just there to protect the teeth. Yeah, it’s it’s not the stopgaps. It’s you can’t get to that point unless you go with the emigrates because again, it’s the journey that’s more important than the end result, because the end result we could all do a dead end result would be compromised if you had to at all is going through the journey. And the thing that stops you cutting corners, going to the journey are the temperate. And please allow me to take the time you see me putting those pictures up on Instagram. I didn’t do that in one visit. I may have done that paper, but three visits driving myself crazy. What allowed me to take three budgets to do the print, the fact that I had a table and say to the patient, I come back in a week’s time, I’m exaggerating, but that’s the only way for me I can get at level is taking as much time as I need next week.

[00:18:28] And then also the hardest skills are for me, I think that sometimes people are losing their skills, focussing on the aesthetics. The adhesive is good, but it still is a piece of mechanical and that’s hands each in the hands of important and also social media. I think a lot of people just focus on the front. I mean, we see Instagram. Pictures, just the cosmetic results I would like to see and you never see the gun margins or you never see a close up picture impression of the guns, that kind of thing. I think I was going to say the thing with Instagram, a lot of it is aimed directly at patients. Yes. Not patients don’t want to see the gun, but it’s dangerous. Dangerous insomuch as you know, if you if you’re only talking to patients, the way the way that you can present the thing is different doesn’t mean you don’t have to be so ridiculous. Yeah. And I guess that’s sometimes the differences. But some market would be pitching it as a dentist, whereas average day, a small kid would be pitching in patients, I think is a different perspective. And then we’ve got Fazila Khan, Osvald and Fazila is one of these dentists who has really humanised the process of implant dentistry.

[00:19:55] During her podcast, I really got a feel for what it was like to be one of the patients and the gentle human touch and problem solving approach she takes to implant dentistry. I found really insightful during that episode that we recorded with her. What I found about the whole teeth in a day process procedure out of all the treatments that we provide in our own clinic is the one that has, I would say, the biggest life impact absolutely. Above and beyond any cosmetic dentistry, teeth whitening, even Payman and orthodontics. Right. Is that you’re actually giving these patients back foreshocks and yeah. The ability to not worry about something falling out of their mouth. Absolutely. Or just a whole new menu of food, right? Yeah. Have you got any stories you can share with those of patients whose lives you’ve changed and what is the one that sticks out that’s had the biggest impact on you? I remember the first one I did, the first one I did was a lady who came and everything was moving to the point where she brought her models and said, you can’t take an impression because everything will come out. So I was already shit scared about what I was going to be doing if I was going to be doing it. So. So that was a big thing. And she was only sixty seven.

[00:21:24] So for me that wasn’t that old. And I sat down and I remember saying to her, and I’ve done lots of versions of this a lot, but I’d never actually done it all in one go. And I always made sure I surrounded myself with people that were a bit better or a lot better. So that wasn’t very difficult. And I made sure and I said to her, OK, so we used these two models, which were OK, and we kind of guesstimated what we were going to do. And I had everybody there on the day and I knew I could do the surgery. And my ex-husband was a prosthodontics, so I knew I had him as a backup. And he we did this as a double act for nearly two years. And at the end of it and I’m not joking Prav we finished a 10 to one in the morning. It was about 10 hours apart, a whole lot. And I remember her daughter coming to get her and everything was fine. I did it under sedation, so everything was cool. She went home and the next day she sent me a photo of her eating and she said, today is the beginning of the rest of my life. And I still have the photo and I still have the text to remind me of how fallible I am and how, yes, this can go well, but how lucky I am and how grateful I am to be surrounded by all those people to pick me up.

[00:22:43] And they do. They operate in for eight hours is no joke. And I was really lucky. And I said to myself, I’m going to do five hundred and then I’m going to go and I’ve done five hundred and three. But but I also decided the last one I’m going to do for free because that will be my best one. Nice. Do you remember your first implant fame if. Oh yeah. I’ll tell you something, it’s funny, we were talking about it yesterday. I have it in my drawer because I do, I have it to look at. So every time I open the door, the surgery is looking at me. Yeah, it happened after 18 months. And I remember saying to me, I’m so glad because I was beginning to worry that you’d think they were. Yeah. I remember every single day, every time I pick up an infant, I remember that you’re only as good as the last one. Really, really. And, you know, I learnt a lot from that. And I don’t worry that the implants will fail because after twenty six years later, you know what to do, because you’ve actually made all the mistakes and you’ve mostly made all the corrections. So by now you should you should know something.

[00:24:00] If we ask if you want to say this question about mistakes.

[00:24:05] Because from from I don’t know if you’ve seen black black box thinking. Yeah, yeah. It’s about it’s about we can learn from mistakes and how in medicine we don’t sort of learn from our mistakes. We don’t learn from each other’s mistakes because everyone hides their mistakes. If you had to think back, what would you say is your biggest mistake and what have you learnt from it? My first big mistake was I was doing a placement with an oral surgeon, actually, and she put the implant in and I said, is it sound? And I wiggled it and it went in the sinus. All right. And I remember thinking, holy bleep, what am I going to do now? And so my choice was right. Well, let’s go back to oral surgery, open it up. We take it out. I remember saying to us that when it happened to him that you’re fishing around in this sinus during this procedure, you’re fishing around. And then he literally set up the patient and the implant fell out onto the floor. And I remember thinking, yeah, OK, so after an hour of fishing around, I suddenly wised up and I said to the patient, can we just sit you up for a sec? And it fell on the floor. And in that moment, I literally looked up at the sky at the window and said, thank you so much. So that I’ve learnt a lot from that.

[00:25:29] I think putting implants in the wrong place, I think almost every kind of mistake you can imagine, nothing life threatening, nothing major, but every kind of thing that is not perfect. I have at least done once, if not more than that. And I think the difference is that when I go to surgery now, I don’t go with a plan. I’ll go with 10 plans. So I always assume, well, if it goes to plan, we don’t need to talk about it and nobody does. You don’t learn anything either. But if it doesn’t go to plan, what are you going to do? Hassan Megaera, somebody who’s a researcher, teacher, mentor, is the bad bad academy and someone who recently I’ve had the pleasure of working with on his personal brand. I’ve begun to realise that he is a true, real perfectionist and a stickler for detail. Obviously, we all majorettes, we wouldn’t be humans if we didn’t make errors. And you know, one thing talking about the pilot co-pilot concept is all about, you know, what can we do to make it better for our patients? And I again, you know, if I want to take one, send one take home message to my friends and colleagues is please think about working as a team. It does help. It does help. You know, let’s put our egos down and think, you know, working as a team.

[00:27:02] One thing I really regret and it really hasn’t hurt me for a long time. I treated this lady. She was my number two patient in UK, in the private sector. And I had a mentor and I invited someone who I used to think is a great person because I was very young and he was very popular. I paid him from my own share as an as an associate to come and deal with me that Saturday. And I treated this lady. And now, you know, 15 years on, I realised that that mentor was literally standing there doing nothing. I he sort of supervised my errors. I placed and put in the wrong direction a place and place to labial. And the patient ended with recession and with metal display. And it sucked because I thought I had my safety net behind my shoulder and I realised now that he didn’t do a good job. So that sort of, again, motivated me. When I accept to mentor someone, I take it there seriously. You know, I’m there 100 percent as if this is my patient. And that’s what every mentor needs to do. You know, it it saddens me to see people claiming to be mentors when they’re not ready to be mentors. And when I say ready to be mentor, not only clinically, but you need to have the passion and the patience to be there as a teacher, which is harder than being just a clinician.

[00:28:40] So that’s something I would, you know, I would regret doing, not knowing the right people to teach me and learning and then teach me how to do things at the very beginning. Obviously, when it comes to dentistry pay, it’s very critical field. If you place your implant one millimetre to labial the whole thing in a film and you’re going to get Middleville recession. So it makes or break the case, the correct positioning. It’s like a domino effect. If the first block isn’t right, everything else would be wrong. So when it comes to dentistry, it’s all about plotting, planning, planning, planning and sharing that plan with your mentor, discussing double checking and. Having no ego, whenever you get ego playing, that’s when things go wrong. Kailash Solanki, my dear brother, love him to bits very accomplished implant surgeon and you’ll pick up some nuggets from him. A lot of what Kailash delivers this is this little bit of magic that is bottled up inside his charisma. And then obviously the skills go hand in hand. Bro, you’re probably one of the highest grossing dentists in the UK, if I do say so myself. What’s your secret to sales? What’s your what does your console sound like? You know what? A patient comes in. Just take us through the experience of a patient coming in, meeting you for the first time and what that’s all about from Doris, who’s a 75 year old old dear to your young influencer who comes in and they’re both totally different people.

[00:30:23] Surely you can’t have the same approach with them all. Now, of course, lik e e very much like understanding people like that, you know, and and what things have helped me be. That guy, I suppose, know working in my dad’s corner shop, you know, having to deal with, you know, the drug dealers, the drug takers, the middle class person that wants his bottle of wine on a Friday night because he’s had a heavy week, you know, in the office to two Doris and who walks the shop on a on a Thursday afternoon with a with a with a wheel in bargain and gets exactly the same things each time. And, you know, having the ability to have a conversation with all those different variations of people allowed allowed me to to build that in my repertoire. So, you know, when when the influencer comes in and current, you know, people will always say, I kind of know I understand language. I’ll talk to them in the language they understand. If Doris comes in, though, she’ll be I will say to her very gently and very quietly, you know, OK, nice to me. I hope everything’s OK. Did you manage to find Azara? Did you manage to cope with those? You know, just things that I know that they’re empathetic with, you know, and empathy is a real big thing for me.

[00:31:41] And it’s not it’s not I’m not putting on I’m not faking it. I’m just I’m always genuinely wanting to make sure that they’re OK. And whether it is the influencer or whether it is the seventy five year old daughter that comes comes to see me. Of course, my approach is different. I taught them differently, the language I use is different. The way I see it, the way I kind of conduct myself, the way I believe in, you know, either give body contact so nobody contact, you know, all these little things just to create some reassurance massively helps. And, yeah, make my take is is always has been, you know, everyone that’s ever worked with me or worked for me or worked alongside me will tell you, you know, I can literally get 95 percent uptake of all treatment plans. The only times they don’t go ahead is if they can afford it and off and pass that, they will go ahead. And so it’s easy to you know, I don’t even think about growth figures. It’s easy to to do a lot of dentistry if the person trusts you and allows you to do it. And I think that’s kind of what I do on a day to day basis.

[00:32:50] But you build trust and you’re saying you almost do that as a second nature thing. You know, you don’t go, oh, I’m going to build trust with this person. That’s the person you are. You build trust and then.

[00:33:02] Yeah, but then

[00:33:04] From such an early age to be treatment planning sort of comprehensively and and having the confidence to, you know, to come out with a twenty thousand pound treatment plan as a VTE. I mean, where’d you get that confidence from both of you? Confident people.

[00:33:23] Yeah, I think what does it come from, from working in a shop where

[00:33:27] People work in a shop, guys?

[00:33:29] Yeah, I, I, I get what you say in light, but from my my point of view, I suppose, you know, there’s there’s two things. There’s the ability to have the confidence to to kind of almost talk the talk. And then the reason I did all the postgrads, you know, and I would say that they’re not mouthes the three year degrees or diplomas or less than the other. But I’ve got the hands on experience to be able to take that to fruition. I’m not telling you that, you know, over that time, I haven’t made mistakes. And I think if any dentist who does the level of dentistry that I do turns around him and says everything I do at every point in life is amazing. And, you know, I’d I’d question that massively question everyone has bad days. Everyone has treatment plans which don’t go quite to plan, even though you feel the special tests and everything you’ve done is, is is is good enough to hold that treatment plan up. Some things do just go wrong. Sometimes shit just does happen. And essentially, you know, that’s also learning. That’s also taught me a lot, you know, that that kind of now allows me to make even better clinical decisions for patients. And we’ve got Karaf around. If I myself wanted to see a dentist Hungar comprehensive, thorough check on all aspects of dentistry, I would have no hesitation in going straight koray first because of his thoroughness and his approach.

[00:35:02] And I really got that from Korei during the interview that we did with him. I have a great admiration for Andrew. I’ve known for a long time. I mean, we we we kind of I knew when I was a surgeon, so I’m talking sort of maybe 30 years ago. And he’s always been innovative. He’s always been at the cutting edge. It was at his practise that I thought I saw no bell really get into gear in the early 90s and his imaging system. And he’s he’s an innovator and he is a spectacular mind to have a great deal of admiration for him. He is somebody who I’m the same. So our practise is multidisciplinary. We deal with all sorts of stuff. But he takes it a step further because he also deals with the cancer patients and the facial deformities and the specialist implant designs and things. So with his imaging, he he is a cut above the rest of these. At least he’s a special guy. And I think, you know, it’s not I’m not I’m not that level in terms of the scope of what he does. But what is what is what is what is your value? Add in the implant world with my value, your value add.

[00:36:15] You know, I do high high level whitening. That’s what I do. Because we don’t we don’t we don’t understand implants tell it was from a normal thing. I don’t think there’s something special about implants as such. I think it’s just it’s just biology and patient management and good, good restorative skills. I mean, I don’t really like the term implant ologies because it kind of signifies to somebody put screws and it’s not synthesised. That’s not the that’s not if you’re a restorative dentist and implants the same as an under five as part of your repertoire, he said the important thing is, is I think realising when you shouldn’t, when you shouldn’t. And what solves that patient’s problems in the best way for that patient? And it’s not necessarily what you would recommend the patient. You know what? I don’t want that. I want this thinking, OK, so the best way of doing it, but it’s a way of doing it. As long as you’re aware of X, Y, Z, OK, we can do that. But sometimes you have to know when the patient says, I want A, B, C, you think there is no way this is going to work. I’m going to go down that road. You have to be X, Y, Z or something similar. And that’s what they said. No way. The thing with Andrew’s practise is, again, is, is a massive practise.

[00:37:28] A lot of clinicians, there’s a lot of different physical activity going on in there and it’s much more difficult for him to control clinical standards at an individual level. I’m trying to keep my practise small enough that I can do that where we all are on the same same song sheet, but large enough that we’re flexible and we have a side that makes it a viable business both to work in and to. So I couldn’t run that practise on my own. But equally, I don’t want to practise for I have fifteen associates coming in and out. I just that that’s that’s a hospital. So I think four surgeries where myself and the hygienist make up one half of the practise of the associates in two surgeries, make up the other half of the practise is quite a good balance. And you know, getting an associate when I talk about associates, I talk about these butterflies in. So I think when you have when you’ve got bees in your in your business, then you you have very, very good thriving practise and you can just take your foot off the gas and lie back and let everybody do their thing. Because they get that. They get the ethos. It’s integral, it’s and you rest easy if you got butterflies and leeches. Not so good.

[00:38:45] And the difference between them is the bee will work as hard as you do. The bee will earn more than you. They’ll do it on social media. They’ll be moving the patients. They’ll be following things up, be doing things to a clinical standard. They’ll be on top of their paperwork. They will be a version of you, me. Those are the ones those are the people I want to cultivate. On the other end of the spectrum, every practise I’ve seen them with, the kind of girl that comes in, complains about everything. Nothing’s ever good enough yet. They’re the ones that don’t turn up to meetings. They’re the ones that don’t toe the line. They’re the ones that don’t obey the rules, that the one that expects everybody to run around them. It’s all about them and them. They’re the leeches. Get rid of them. And they’re the people that are going to take your patients and run off to to set up their own practise. So those are the two extremes. The difficult ones are the cheap. The bees get rid of the leeches, the problems of the butterflies. You start off as a caterpillar, sort of eat everything and they kind of get into the practise, the wonderful and it turns the wonderful butterflies and they are there with you and they’re lovely and everybody loves them.

[00:39:49] And their quality of work is good. Nobody really complains about them. They occasionally drop the ball, but they find in the sweet and the charming and everything. But they don’t really add and you don’t practise. They don’t really bring in any patience. They don’t really do anything. It’s just a job. They come in, they go home. And those butterflies are the difficult ones because they don’t really help build your practise. But on the other hand, they kind of it’s nice to have them there. And the butterflies are the most difficult societ, because if you push them to try to raise the game, they shrink back. And if you don’t give them enough, they get bought. Those are the typical associates and you don’t always know what they’re going to be. But if you can find bees, pay them well, keep them busy, keep them happy, give them everything they need, because that is going to be your future. And then Palmer, probably one of the most educated dentists, especially for his years that he’s been in the game, quite a young dentist, got a very mature head on himself, both from a business perspective through doing his MBA and experience in the business of dentistry. But on the implant side of things, he’s really educated himself, got himself out there, even run his own courses. Great concern shared by Neelesh.

[00:41:08] So what would you say to a youngster who wants to get into implants? Would you now say MASC or would you say go find some courses, long courses, short courses?

[00:41:20] It’s it’s a hard one, isn’t it? What I’d say is, where are you in your career path? Can you do surgical? Can you take teeth out? If you can take time then consider implant work. If you can’t if you’ve got that whole in your repertoire, you need to plug it restrictively. Are you competent? And then it’s a question of doing a course and then finding a mentor. The masses that are out there, I don’t have enough experience of them to comment on whether or not they’re good or whether or not they’re bad. But I know that there’s nothing as good as the guys programme anymore. I mean, you have people getting messages from certain universities only doing like five implants or something, and we must have done twenty, thirty loads. But you need a good mentor. So some of the guys who I work with now who did my course mind and of course I still mentor them and it’s nice to see that they’ve progressed, but he’s taken three, four, five years. It’s a really slow burn, but you have to be all it. You can’t be doing implants and then also be doing this and that. And that implant is the one where you just need to dive in and really go gung ho into it. It’s it’s a hard discipline, but the rewards are very good because there’s not enough dentistry. And to me, to any youngster, I wish I would only be a youngster to any like young the dentist. I say, look, and this is from the financial side.

[00:42:40] If you want to learn, you’re going to open up a shop, right. Let’s say you open up a shop and the shop next to you is selling coke and the shop on the other side is selling Coke. Why are you going to open up a shop selling coke? Only going to do is be a price war. You’re going to have to sell the cheapest Coke Pakhtun if you are a dentist. Why are you learning Invisalign Botox Lutfullah composite restorations when every other dentist is doing the same thing? Why don’t you offer a different service line? So who’s not offering anything? And it’s hard to come by nowadays and implants. So if you differentiate yourself from the early days, your market share. By default would be bigger because if you’re in a town and there’s 10 dentist incompetents and one dentist implant, guess who’s going to be the busiest guy? And then you can almost set his price, right? So that’s what I would say is the speciality that is the least service in your area and then go for it. And Implant’s, I think, is is an amazingly rewarding area of dentistry to do it. And I would like more youngsters. And I think definitely we need more women in dental implant surgery because there was even a women in Implant Dentistry Foundation and we had a female president of the Aidi. And I think it would be great to have some more diversity in implant industry. I’m sick of going to implant conferences and just seeing bald heads in the audience and present company excepted.

[00:44:05] Is this all you get is not to go and this is your room. And then Paul Palmer, one of the eggs of implant dentistry. And what was the takeaway I got from Paul Palmer’s episode was the you know what? It’s important to choose the patients you treat rather than have them choose you. And, you know, I think over the years he’s he became more selective and understood what to avoid, what not to do, because it comes up a lot with people I speak to. And that’s zygomatic implants. And you’ll I just want I just want your thoughts on it, because you know what? I’ve come across some dentists who jump on a weekend course to learn zygomatic implants. I personally think that’s bonkers. And then whatever your philosophy is on it, what sort of training and qualifications do you think somebody should have to be doing that, that level of surgery? So, you know, that’s always a tricky one. I’m not staying at the door letting people in and excluding people. So I think it’s dangerous to even venture down the line of who who should or shouldn’t, because at the end of the day, the person holding the drill is the one who has to answer for himself and the GDC. So is not how Australia if I don’t what courses you’ve done at the end of the day, you’ve got to be able to be confident in your own ability and working within your own abilities.

[00:45:39] You know, again, is what we try and instil in our students and our the people we work with. Because once you lose that insight, life gets difficult and dangerous for all of us. But, you know, the employers myself, you know, they have a good enough record and in the right hands, they certainly have a place. But what they actually can deliver again is another one. It’s a common philosophy and one used by by Borris of late, which is under promise and over deliver. And I think once you’re at the level where you’re starting zygomatic in your stance across the lines where delivery could prove very problematic. So just proceed with caution would be my word with it. It’s not something again, we know well our level of expertise. And when it comes to that, well, we’d found that out if we felt it appropriate, then have anyone within our practises who actually provides that. Last but not least, the Zacky Nozaki, one of these guys who when I first got into the Dental industry, he was the man who I recognised or identified with being situated in some of the top leadin practises in London. They would rely on Zachy to deliver their high end, high calibre implant dentistry. But on a more personal note, the guy is an absolute pleasure to be around a great host and great to be in the company of as well. And so enjoy this episode and hope you take away some plum nuggets.

[00:47:32] You do so many different things. You you work at them plant ologist in lots of different practises. A drop in the blooming sort of.

[00:47:40] Yeah. Peripatetic. Yeah, I used to do that. I don’t do that. Not much anymore. But a funny story is, is that you know, when the recession kicked in 2009 and you admit a lot of my friends that did implants and they’d be like, yeah, it’s a bit slow, it’s really hit us and I’m not doing that many or how about you? And I’d be like, I was busy as as hell, you know, I was like, no, I’m it’s great. It’s you know, it hasn’t affected me at all. The difference was, is that they sat in one room, in one location, in one clinic. That area. That area. Yeah. Whereas with me I was like. I got off my arse and actually found the work and a lot of people said, oh yeah, you know, do you like what you do going around, whatever it’s like, you know what? At least I was busy. At least the money was coming in and I made lots of connexions and networks. And and then when, you know, when we opened our practise stuff, I started reducing. Although I didn’t want to travel so much back then, I used to even go up to Scotland. I used to do all on fours. Really? Yeah, I did a couple of even Fairlane up there in Cherry Bank when I was you know, we go to Gleneagles every year, get one of these timeshare things up there. And even once I was there for a week, she’s like, can you come over? So, you

[00:49:01] Know, I’m just going to ask you, though, you visited lots of practises. You can see lots of different ways people work. What are some of the takeaways? I mean, what are some things you learnt that you then put into your own practise?

[00:49:14] Well, one thing I learnt was the bigger the practise, the harder it is. I mean, it’s obviously just common sense, but it was exponentially harder because you’d have to keep everyone busy and you’d have lots of staff turnover. It was it just seemed a lot harder. And on the face of it, people look at these practises from the outside and think they’re running smoothly and whatever. However, when you’re on the inside, it doesn’t it’s not always like that. And that’s why we did something small. So when there’s a recession, when times aren’t great or there’s less patients coming in, I don’t have to worry. I still remember shortly after setting out my practise with with Dominique, my dad got ill. I had a phone call from my sister. I was actually at a board meeting at a college, said, Zacky, you got to come right now. I literally took the next flight out and I was away from our new clinic for seven weeks on the trot. And I was all I was thinking, I was like, God, what’s going to happen? I’m the one doing the high end implant, you know, treatments, thousands of pounds and I’m not there. The nice thing was that the rent is low. It’s a small practise. There’s not a huge sort of monthly expenditure on staff wages. Not that there is, but it was manageable. Now, if I had a much bigger set up and I remember talking to several people and they’re like, you know what, you’re so lucky you’ve done something small. And whilst you say I was ambitious and wanted to open up multiple surgeries, that’s my comfort zone. I’m happy like that. And I’m happy also working and placing implants for other people, which I still do to this day,

[00:50:58] That this is Dental Leaders the podcast where you get to go one on one with emerging Leaders dentistry. Your house, Payman, Langroudi and Prav Solanki. Thanks for listening, guys. If you got this far, you must have listened to the whole thing and just a huge thank you both from me and pay for actually sticking through and listening to what we had to say and what our guest has had to say, because I’m assuming you’ve got some value out of it

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