Finding Your Niche in Dentistry – PDP076

Jaz’s Introduction: Find your niche. Now, that’s a saying that’s probably been bonded around a lot, in all the sort of circles of career advice is something that I heard a lot in early on my career. And it never fully made sense to me. I’m hoping it’s gonna be this episode that’s gonna make the whole concept of finding your niche tangible. What are the benefits of finding a niche, how to go about it? And what does it actually mean? Now, I’m joined by someone who is quite inspirational for this episode, because he is someone who’s quite openly admitted to failure in some ways. And I do believe failure makes you stronger. And we talk about some struggles and failures early on in his career. And I’m very honored that Dr. Pav Khaira shared those failures with us because that’s how we can learn about others experiences. It’s not all rosy out there. And with that failure, or with the struggles, he was forced into trying different procedures, try and boost revenue for the practice. And through all that, eventually, he found his niche. And then he changed his niche. So he is a living example of no matter how qualified how many years of experience you have, that if you still are looking for that right niche for you within dentistry, then opportunity is still there. And if you’re at the very early start of your career, just use this episode, use the lessons from Dr. Pav Khaira as an inspiration to helping you finding your next steps and your niche. Protruserati,I’m joined by Dr. Pav Khaira from the dental implant podcast to talk about his niching down into implants, my fears about dabbling into implants and my challenges in terms of getting started with implants and the recipe to finding your own niche, whatever that may be for you. So the very relevant Protrusive Dental Pearl I have for you today is to sit down. And maybe at the end this episode, just take five minutes to get a pen and paper and write down all the procedures that you like to do, all the procedures that you’d like to do more of and get known for. Now, I don’t mean like an Instagram celebrity or anything like that. What I mean by that is someone who your colleagues, your peers respect, because you are the go to person for that procedure, and doesn’t even have to be in Europe, in the UK, in the world, whatever it can be in your town, if you can be known in your town for a certain procedure, then that itself can carry so much success. So there’s so many benefits as we discuss about finding your niche. And I want you to make a list of all the things that you like doing or that you’d like to do more of, and you won’t be known for. And also make a list of the procedures that you just fell out of love with or you don’t enjoy doing, or you’re not very good at for a reason. And either decide that you’re not gonna do those anymore, or decide to upskill in that because part of finding your niche, as we discussed in your episode is becoming comfortable in your skill that you’re not gonna be doing all the procedures and you don’t have to provide all procedures. So it’s an interesting topic. I hope you find it very useful. Let’s join Dr. PaV now, let’s not wasting time and I catch you in the outro.

Main Interview:

[Jaz]
Pav, how you doing?

[Pav]
I’m good. I’m good. It’s Yeah, I’m about to start work at Evo so that I’m not doing surgery today, which is really strange. To do surgery like for me four days a week I normally do surgery, at least three if not four days a week. So coming in on a Monday not having surgery. I’m just like, wow, okay, that’s weird.

[Jaz]
What have you got planned today? What was the kind of agenda for treatments today?

[Pav]
It’s just a review appointments and and consults basically. So it’s one of my other colleagues. He’s he’s doing the surgery today. And then I’ve got some pretty interesting cases lined up for the rest of the week. So yeah, it’s good.

[Jaz]
Yeah, amazing. Well, for those who who don’t know Pav, I’m going to give my little introduction before you can do your official one. But Pav is the host of the dental implant podcast. And he is a friend that goes back, I’d say, a large proportion of why I started to really get involved with occlusion and splint therapy and APMSAs was because of you. We invite you to our study club back, about seven years ago now. And he came in London and you just inspired me so much. I think you remember that night, right?

[Pav]
I do remember it. Yes.

[Jaz]
So you said something off at that time, my friend. So it’s great to have you on the show today because you know, you’re so important, important cog in my journey and really important mentor if you like. So it’s been great to see how you have niched into implants since then. And you know, what a great way to introduce the theme of today’s episode, which is a niching down or if you’re in the US or somewhere else niching down, which just sounds wrong. But Pav, tell us who you are for those listening around the world. And you’re about your new journey as a podcaster as well before we dive into the nitty gritty

[Pav]
Yeah, so it’s for those listening to my podcast. This is a Welcome to the next episode of the dental implant podcast. And Jaz, I just want to say, apologies for sucking you into the black hole of chronic pain. You know, it’s a weird journey. But yeah, I do actually remember that evening. A lot of you were asking all the right questions, and I remember thinking to myself at the time or like he gets it or like he’s like, on, fire with this. And similarly, it’s, you know, I think we spoke a few months ago. And you basically turn around and said, We have we’ve got a lot of information, why don’t you set up a podcast. So in that context, you’re my mentor, you know, you give me advice on how to set things up. So a little bit of background, about myself, it’s I graduated in 2002. From Guy’s hospital, I purchased my own private practice in I think it was 2004 2005, I struggled along with it for the best part of nine years, ended up having to close the business I as well as closing the business, because I’ve given a personal guarantee on it, I ended up going bankrupt as a result as well. And after that, it was just like, because I’ve received bad business advice from a lot of people as well.

[Jaz]
Can you give an example, I mean, generic bad, what is an example of bad business advice, if you don’t mind.

[Pav]
So a generic example of bad business advice. And this has happened to me where people are turning around and saying to you “you can turn your business around, just do this, this and this, keep paying me I’ll keep telling you what to do” was what they should have done, or what the law says they should have done is looked at my box and turn around and says, I’m sorry, Your business is insolvent, you should pull the plug. And it was actually an external person who came, who ended up, she was actually a patient of mine and I can’t remember how we got onto this subject. But I told her that the business was struggling. And she goes, Well, you know, I’m in finance, do you want me to look at the books and I looked at her and she just came back to me, she turned around and said, You know what?You need to pull the plug. What do you want to hear it or not? She said, you’re going to lose this business at some point. You’re going to be better off doing it sooner rather than later. But I said to her, you know, my business coaches were telling me it’s okay, they will be able to turn the business around. And she goes, I don’t know who’s told you that but that’s not appropriate. So it’s, that’s when I realized that I was much more comfortable as a clinician, as opposed to a business owner. Some people thrive as business owners, and I’ve got great friends were they own practices, and they’re exceptionally busy, exceptionally successful. It just wasn’t for me, in terms of clinical work, I was far far far more comfortable in that,

[Jaz]
I would definitely say on the same path. I get asked all the time, Jaz when you open your practice? And I guess, it’s something that I’ve really thought hard about, but I feel exactly the same as you, I feel like I love my clinical dentistry and other pursuits and passions. So, to devote my time to all the stressful yet rewarding activities of a thriving business owner, multiple practices, that kind of stuff is just not for me and sometimes self realization is such a huge proponent in your success in the future knowing what you actually like.

[Pav]
I think the flip side to that coin is there’s a silver lining in every card Jaz is because I had a business which was struggling, I was constantly not, I need to bring more income into the business, I need to reward incomes, I was learning a lot so I had a lot of training in fixed removable prosthodontics I did a lot of training in the US with Frank Sphere. I was one of the first to implement Six Month Smiles in the UK. And in fact the guy who said he was the first to implement Six Month Smiles on the UK, he was on the same course that I was and I went down the Ortho route as you know, I went down the Chronic Pain route for quite a few years for as. I could do format reconstructions, IV sedation but what I found is a whole host getting bored clinically quite a lot, as I’ve started.

[Jaz]
But why you had so many different variations. I used to mentioned all the things and it ties in so perfectly well my main questions which I think you can just ask now because it’s perfect timing is being the jack of all trades, which sounds like you were you’re doing your sedation, ortho, complex reconstructions, fixed removal, that is for me, the super GP, right, super GP territory. So why not have that and why then eventually decided to niche down?

[Pav]
Well, for example, when I was doing full mouth reconstructive work, either arch or full mouth, when we first start doing it, there’s this rush, there’s this whole, I need to learn this, I need to do it this way. And then it gets to a point where you’re proficient at it. Now, I’m not saying all cases are easy, but you end up almost going through the motions a little bit. And you’re like, okay, as long as I follow these steps I’m not going to have a predictable result. And the only thing that really started to capture my interest and this is ironic actually where I am now is when I first started is I was like I’m not doing surgery, I hate surgery. I’m not doing your implants, I was told that about I’m not placing them because I was afraid of surgery because I didn’t have the clinical knowledge and the experience. And after a while when I got bored with the rest of it, I was like, Okay, let me do an implant course. And well, it just took off from there, you know, I started to realize quite quickly, well, the reason why I like implants is you do actually have to think of the restorative you’ve got to think of aperio is there’s a lot of times you’ve got to think of ortho. So for me implant dentistry is is actually all encompassing, it encompasses everything that that I’ve learned so far. And for me, it was just a natural progression to start to niche down in implant because I found more than anything else. That is what I loved. And I think we we hear this a lot. And we don’t take it on board, in that a lot of people here, you can’t be a master of all trades, you can be relatively proficient at a number of different things. But it takes a long time to become extremely proficient even in one thing. So to multiply that out becomes very, very difficult. I’m not saying that there aren’t people out there who are supremely proficient at a lot of different things, because obviously, that there are people out there. But what happened for myself is I just got to the point where I enjoyed him quite so much I started to progress more down that route, I was doing more courses, I ended up doing my master’s degree. And this is like a natural progression in anything. So what ended up happening is slightly as I was only doing implants in my practice, then I was branching out and doing implants in other practices. And quite recently, about 10 months ago, I got very lucky and very landed on my feet. Because I joined the team at Evo dental. Now, if you think placing just implants his niche, well, at Evo dental, all we do is treat full arches and full mounts. So My typical day is a do arch 10 implants. And you know, we do that we do that five days a week. So for me, it was almost like a natural progression, moving from boredom and necessity to bring more income into the practice to all of a sudden finding something that I love. And starting to expand those skills and the niche travel I developed itself. I did, as I said, I was lucky. You know, I’ve ended up at Evo, but it was just a natural progression that was doing more and more implants.

[Jaz]
Thanks so much that very honest reflection on how it started in terms of the necessity to keep your business running afloat and having to dabble in different skills and upskill yourself and eventually, almost by accident landing into implants because you thought okay, let me try a course. And it just took off from there. I guess to use analogy, you had to kiss many frogs before you found your prince, then what would you give? What advice would you give to young dentists? A couple years qualified which which they hear this advice, right? And then I’m hoping In this episode, we’re gonna make it really tangible because you hear this all the time. The the Guru is always saying find your niche, find your niche. But if there’s no predictable formula to find your niche that you might just accidentally fall upon it, you might have a mentor that inspires you. So I do feel as though how can you find your niche? If you haven’t given a chance I my niche might be endo. And I haven’t discovered it yet. Because I haven’t given endo a chance. So what would you give to someone first five years qualified or even 10 students or in that sort of young dentist category to help them find their niche.

[Pav]
Some people will never actually develop a niche. They’ll be quite comfortable in general dentistry. But the other thing I would say is don’t rush into trying to find a niche too soon. Let’s go back as that this is actually what happened to me. I was like, Okay, my niche is going to be cosmetic dentistry. It’s going to be veneers, it’s going to be format reconstruction, then it’s like okay, well that didn’t work. Now my niche is going to be orthodontics, and then after orthodontics, that’s when splint therapy came out. And I’m actually just progressing to into implants. Now, there are some people where they’re just like, you know, I want to become a specialist. That’s great. Go for it, okay. But if you’re in general practice, it’s important to extend your skills and learn more, and you’ll just get a natural affinity to one thing above anything else is what I think happens. So I think the issue with trying to niche down too soon is Hello, I jumped into implants right from the start. Well, actually, I’m actually a better implant surgeon. Now, because I understand chronic pain, I understand well, actually, I understand the forces going for my implants forces going forward from back in time prosthodontics. I know how to deal with them. I also understand the orthodontically. Even though I don’t do the author, I understand orthodontically what can and cannot be achieved and how it can improve my income outcomes. And because of the restorative work that I’ve done, and the training that I’ve had, I understand occlusion as well. Now you and I, we both sat with we as ER and he understands occlusion to a much higher level than what either of us do by professionals. And so this is the benefit of not meeting Too soon is that it gives you much better rounded ability, when you do actually start to niche down, you know, for examples, some of the better endodontists that I know, they also like placing implants and they can make that judgment call Wow. As to whether a tooth can be restored or whether it should be doing implants. Now, even within implant dentistry, it’s really important to understand those different niches with implant dentistry. Okay? When you first start, we always recommend placing implants out of the aesthetic zone towards the back end of your bridges, okay, then you can start to build up your proficiency in immediate implants, then you can start to build up the proficiency in grafting and grafting is not easy. No, people think, oh, you slap on a little bit of bone membrane, you’re great to go. It really isn’t easy. There’s different ways of doing it. There’s different indications for different methods. And it’s not always predictable. So you need to understand how that is. So I know some people where they will build a niche within implant dentistry and within the subtopic, of grafting, and then obviously, my niche at the moment is not even just within implants, is it within full arch reconstruction, because that’s what we do here all day, every day. And it’s just been a natural progression for me. So the advice that I would give to the younger dentist is a Don’t be in a rush. But I understand why you feel you want to be in a rush. I was in the same situation as you as well. I was like, I want to do this, I want to do it now. Okay. I see a lot of people, as soon as they as soon as they’re coming out of university, they’re like, I want to be a celebrity cosmetic dentist. There are people out there, I’ve been graduated since 2002. So that’s coming up to 20 years, I’m very good at my aesthetic work, there are people out there who will just walk circles around me because they have niched down to this. So highly professional. So what I was expressing is to the younger colleagues is I understand why you want to niche early. Sometimes it’ll work out sometimes it won’t, but have that flexibility that if you start to do something, you’re finding that you’re not enjoying it, you can shift into something else. You know, that’s what’s happened to me sounds like, that’s what’s happened to you on a couple of occasions as well, it is really satisfying when you find that thing that you really love. Yeah. So the benefits to outpatient because we’ve focused only on full arch implant is we end up being very proficient at it. And we can intercept problems before they actually, before they actually cause problems. Because you just exposed to it all the time. You know, if you’re doing one or two arches, or one to four miles idea, you’re not going to build up that muscle memory. In order to be able to really help these patients when you do it day in and day out, you’re immersed in it. And this is what happened when I started at Evo dental is I started right at the beginning of the training pathway. And I was just immersed in it with my mental. And I’ve progressed progress really quite quickly because I had the background and implants already. But you find that that muscle memory builds up really quickly when you’re doing it all day every day. So you need those 10,000 hours, you need that you need a good amount of time and exposure to it. To be able to build up that muscle memory.

[Jaz]
I think the two takeaway points and reflections from what you just said there was a not to rush and be be open to the opportunities for learning. They’re out there. And eventually you will automatically be attracted. Like for example, Rena guardia once told me when we had this guy having the same similar discussion about seven years ago, she was saying that automatically when you get their dental update in the post will be DJ will automatically start flicking through the pages that interest you just subconsciously. And you will slowly just through the forces of nature start to find the affinity towards that micro speciality. And I guess this was echoed to me by periodontist, saying that try and become the best person in competence for the best person in Perrier be the go to guy for sedation. And I think there is a lot of power on that, like you are becoming the go to you were you were definitely the go to guy for splints. And now you’re definitely the go to guy I think you’re emerging in a full arch implant case. I love your passion. I know you’ve studied so hard extra qualification stuff. So it was great to see you blossom. And I think it’s great that you have that story. Because it’s inspiring to young dentists who, who maybe feel as though they can’t change that needs to fall down that rabbit hole. It’s not the case, you’re living example of that, that, you know, you’re 20 years qualified, but you’re not slowing down anytime soon, right. You’re You’re still exploring this niche that you found, and it wasn’t something that you had from day one. So that’s epic. And one more thing that I’ve thought of is the riches are in the niches. So obviously it’s niches but you know, to make it all work, the riches are in the niches and I truly believe that once you can be the go to person for that one field, you’ll be rewarded for it.

[Pav]
I think there’s two sides to that sword, but you’re at Right, my training, my passion hasn’t slowed down at all. So the next stage of training for me is psychometrics. So we’re already in the process of being trained, because dogmatics, I’ve done some courses. And at UVA dental, we’ve got one of the most experienced zygomatic surgeons on the planet, joining the team next month. So my mentoring is going to be done directly under his supervision. So even within the niche of full arches, there is another subset niche, you know, you can just keep going and going with this. So I think the the upside to it is, when you start to lose down, there are people who can, from a business point of view, we can start to compete. Okay, who but what I was saying about that do leg short. And the other issue is, is a lot of people don’t understand it. So if you won’t get the referrals, but the patients don’t understand, I mean, let me give you an example, jazz is, you know, as well as what I do is that, you know, we can turn around and say to patients, we don’t care, if you’ve had migraine for 20 years, there’s a solid chance we’ll be able to get rid of them, they don’t believe you. And so generating that marketing to push the patient so that they understand that we can help them, because they’ve never heard of it. And quite often these patients have tried everything under the moon, they just think it’s another way to scam them basically. So the upside to the issue is you have a very strong skill set, which very few people can can compete with. But the downside solution is fewer people have heard of what you do. So it’s harder to generate that business. But once the once the momentum of that locomotive starts, then it’s hard to stop. It takes time, it takes effort. So anybody who’s listening needs to understand that it may take you 510 1520 years, but you know, don’t expect it to happen overnight. You know, it’s there was an old saying I can’t remember who he was. And I think it was a singer or all of a sudden within the space of four or six months became extremely like world famous. And people said, I remember reading in an interview somebody turn around, etc. How does it feel to deal with this overnight success. And he said this overnight success I’ve been working on for 20 years. It takes time to build. And people are in a rush nowadays, the world doesn’t work like that. Keep working hard, keep studying, we’ll eventually get there. And if you don’t want to be sure you’re quite happy doing general dentistry, great.

[Jaz]
That’s a niche in itself, I really was waiting for that message. Because it’s so important because lot of people don’t want to niche down to a specific area. And they love the variety. They look at their day list. They have children, they have some perio, they maybe have an implant in a premolar region, they have a root canal. And they love that and they’re great. And that’s good. So that itself should be respected. It’s great to have that. And you can market yourself more widely, which is a great point you made about the downside of niching down, I think the two themes that we need to explore in the next 1520 minutes or so is a if you start niching down the fact that you have to become comfortable to not doing model render anymore. For example, like let’s say I’m niching down into implants, as you have, I need to build that muscle memory and therefore I’ll be doing less of endo, I’ll be doing less of some other procedures basically. And then it doesn’t make you any less of a dentist because you won’t be able to do that stuff anymore. You have to be comfortable with that. And I want to hear your take on that. And then B let’s talk specifically then about niching down into implants for for the young dentist because I can share some experiences. And some reasons why I am hesitant to start dabbling in implants. Because I feel as though I need to go all in if I do implants. So we’ll discuss that theme as well. But let’s start with that. First one is about being comfortable in your skin that you now can limit the procedures that you do, it’s very hard to start

[Pav]
with, because it’s going to the first place it’s going to hit you as your wallet when you are trying to increase your skin and something but you’re not very professional to start with it takes a lot of time to be able to do even the simple stuff. And to dedicate that time, you’ve got to drop down other stuff, which is bringing you in income. So the first place is going to hit you as your wallet, but you just have to be comfortable with it. So when I own my practice, I did actually I did actually under microscope, I was actually pretty damn good at endo. But then I ended up having to sell my microscope to try to keep the business afloat. And I found out very quickly, I can’t see I can’t do endo anymore. And then I ended up referring all of my molar endo out. And then very shortly I was referring all my mother and pre molar endo out. And not too long after that. It was just like, No, I don’t want to do anything there whatsoever. And that’s that then starts to free up your time. So it’s important to realize that because it takes time, it has to start with that passion. Because if it doesn’t start with that passion, you’re just gonna turn around and say I’m sorry, I’m not prepared to drop this income and it will impact your income to start with it just naturally does. But then what happens like for example, because I’ve been doing implants for a long time now, if I get a very straightforward implant case, and they’re not, they’re not all like this, if I get a very straightforward implant, let’s say single implant, when I first started placing implants is it may have taken me three hours to do that case, I can now do it in 12 minutes. And I think the fastest I’ve placed an implant from the patient coming in to the patient leaves me with about eight minutes, including anesthetic. But that didn’t, I didn’t get to that position overnight. When I first started at neuvo, my average length of time that he took me to do a jewel arch is about five hours, five and a half hours. Now my average length of time is just under three hours. And that’s good, more complex cases that can take a little bit longer, you know, straightforward cases, to two and a half hours. But again, that didn’t happen overnight. That happened because I was immersed to it every single day, I had a mentor sat on my shoulder saying, don’t do it this way, do it this way, we’re going to get a more predictable result, it takes time. And you have to, you have to be able to let go of what doesn’t interest you to grab a hold of what does interest you know, you can’t you can’t hold on to two things with this thing pulling this way. And this thing pulling in this way, it doesn’t work. At some point, you have to let go of this vine to swing further on this fine.

[Jaz]
Well said, great analogy. And I think a lot of people need needed to hear that actually something is really important to hear that message. As you know you otherwise you completely oblivious or like you said, if you don’t have that passion, that only then does the decrease in income really start eating at you. But when you know there’s a purpose and an endpoint and you’re trying to upskill other areas which will hopefully reap rewards in the future, then you can you can be comfortable with that drop in income.

[Pav]
Sorry, I was just gonna say, one of the rewards that’s come from me from moving into implants and not even just dabbling in it a little bit. But really studying and grappling harder is I’m now in a in a position where my skills and my knowledge are indispensable to the practice that I work at Evo. So he’s actually jumped security for me, you know, so it’s, when you have that niche, it actually improves your job security as well.

[Jaz]
Absolutely. With implants. Now, I have dabbled placed a few with under some mentorship and guidance. And I just felt as though there was so many complications, surgical complications, technical complications, restorative complications, things like cold welding, which I never knew existed, and it happens to things like a screw being over tighten. Now you can’t unscrew it, things like someone comes in and you see on Facebook all the time, which implant is this or have a patient in Ealing, and they have this type of implant. And there’s so many different brands, that I just feel there are so many challenges, and I know you’re the best person to advise me. But the learning curve for implants is steeper than I’ve seen in any others and this from actually placing and going through that sort of procedure. So he but what people told me is that to place an implant is easy just to do actual procedure is easy. But it’s nothing simple about the overall overarching concept when it comes to healing as well and patient selection. But restoratively, the more complex you get, and the more challenges you are faced, it’s very, very difficult to perfect it. So what do you say to someone who may be because I hear this from young dentists all the time that you know what, I don’t want to get into implants, because it just seems like way too crazy for me.

[Pav]
So what I would say to that is, there’s two things that I want to address. Don’t be afraid of implants. You know, I’m living testimony that, you know, it can be learned, you know, I didn’t, I wasn’t born with this knowledge, I wasn’t born with this skillset, it’s taken me time to develop it. That means that it’s cost me a lot of money in terms of education is helpful cost me a lot of money in terms of equipment, and it’s cost me even more money in terms of mistakes. This is why I keep harping on about mentors, because when you start doing this type of work, and particularly more complex that that starts to become is you’re either gonna pay to fix your own mistakes, are you going to pay to a mentor to avoid those mistakes, but one ends up with a happy outcome that you’re still going to pay one way or another. I think the other side of the coin as well is and I see this a lot, where people are like, Okay, I’m going to do a one year course on implants, I’m going to do one day, a month, over 12 months, and I’ll be able to do full arches, I will be able to do absolutely everything I will be able to do that. It doesn’t work like that. It’s significantly more complicated than that. Okay. Like you said, he’s, you know, choosing your implant system, then you need to learn how to use that implant system, then you need to understand the biology of patients. You know, we’re talking about things like gut bacteria, which can affect healing, psychological stress that can affect healing. Vitamin D, we are talking antidepressant use, we’re talking proton pump inhibitors, you know, all of this stuff adds up. And so a straightforward implant case isn’t actually a straightforward implant case. So what I would say is, don’t be overly daunted about starting but understand that what’s not going to happen is you’re not going to do A one year implant course and be able to do everything. Like what people say with regards to your BDS. Once you’ve got once you’ve done five years at university, we’ve got your BDS, that doesn’t mean you’re a good dentist, it’s a license to start learning, once you’ve done your basic implant course, is that’s a license to then start learning. I still go on courses, I’m still learning lots, I still read papers every single day. So what I would say is the journey of 1000 miles starts with a single step. So you have to take that first step. But also understand that this is not going to be done overnight, you’re not going to get to the end of a one year course. And all of a sudden, people are efficient. And the other thing that I hear as well. And this happens a lot in America, where people like, oh, I’ll go to the Dominican Republic for a week, I’ll place 15 months in a week, and that’s gonna make me a great surgeon. No, because you don’t have the follow up of those patients, you don’t see the mistakes. You know, I’ve still got cases from a few years ago, when I’m only just fixing now, which have cost me an absolute arm and leg because I thought I was proficient with full arches, I did a full arch, it didn’t go according to plan, the patient’s not going to pay me again. And this is what I said in my last podcast as well jazz, in that, you know, is if you do a an emo restoration on a lower six, and it breaks, we’ll find the patient comes in patients not particularly happy, you can really hear my restoration. There. Imagine what happens when you do a six unit implant retained bridge, and you put in three or four implants. And that doesn’t work. And all of a sudden when your your implants is fractured, that correcting that is significantly more complicated. And it costs you a lot more money out of your own pocket.

[Jaz]
That’s exactly what I mean by you know, it becomes more complex, but then the the failures also become way more complex way more stressful, which is why some dentist saying you know what, I’m not ready for that. But I think what I’m trying to say is, is there a place for dabbling in implants? You know, I mean, like, you know, yeah, God tells me, can you just do the, you know, one implant a month or replace a lower molar, and then keep it at that

[Pav]
some of the most successful dentist, and these are the ones where there are general dentists that require a lot of different things. But what they will do very, very successful is they’ll do an implant course. And then we’ll pick cherry pick and choose the easy cases, the more complex cases they will either refer out or they’ll get somebody into the practice to do it for it, just because it is the same as ortho jazz, you know, if you’re doing orthodontics, there’s a very big difference between, you know, our we’re going to do, we’re going to do short term, although because the patients have a little bit of relapse, everything towards the back is fine, I know that this is within my skill set, we can get it done in about six months, okay? versus You know, this patient is orthognathic surgery patient, you know, you don’t do an ortho course, and all of a sudden start being orthognathic surgery cases. And it’s the same with implants is, you know, you can do you have ridges towards the back of the mouth, what’s the most commonly removed to the mouth, it’s upper and lower fast motors, because they’ve been in the mouth longer, they’ve had more time to students, you know, so if you’ve got a lower molar that’s missing, there’s a ton of bone in his heel, great, absolutely go for it, there’s a lot of business to be done. And it’s less stress as well jazz, because it’s out there, the smile line, it’s nothing complicated. And then if you get something in that needs a sinus lift, get somebody in or refer the patient, you know, the patients will actually respect you more if you turn around and say to them, Look, I can’t do this point. This is more complicated, but

[Jaz]
I think that’s a great message for those who like me sometimes think ah, is it worth it, but if you do, just like they do on the ortho courses, you start with your class one base relapse cases or in the implant world, the sort of analogy would be or the similarity would be a lower and upper first molar out of the smile zone and build from there, you never know that might be something that interests you more and more and then you end up doing more courses, soft tissue courses moving to anterior or you might just stay as keeping that as part of your larger skill set. And then you can do that but you have people to refer to so I think that really does help actually and I think I’m hoping that’s gonna help a lot of people listening as well in terms of who are afraid young dentists are afraid to get involved with implants because they know that the field can be famous for or infamous even for its complexities and and litigation or the justifying the higher fees of indemnity because I the flip side of that Pam, and I’m sure you know loads of these as people who have done the one year course for implants or people who’ve done an MSc and then never went on to place an implant again.

[Pav]
Yeah, you know, I hear it all the time. You know, people do MSC, they’ve placed four or five implants, and they still need mentor and all that they just don’t do it because they haven’t built up that confidence. You know, okay, let’s say stop somebody start placing the simple implants and all of a sudden they want to progress. And they think right, the next thing for me to do is to learn how to do sinus. Well, sinus lifting is complex in itself, you know. So, first, you got to go on a finance lifting course, which is going to cost you three, three and a half 1000 pounds. You’ve then got to get the same as Medicare and there’s different lists for different indications. Then you need to go to your indemnity indemnity is going to tell you are essentially right as soon as you’re going into sinesses, right, we’re adding two and a half 1000 pounds into the premium. You know, if you’re doing one or two lifts per year, is it really worth it. Whereas if like what we do at Evo, if you’re going into the science 234 times a week, then obviously it is worth it. And you build up that skill set, there is no harm at any point, turning around and saying this, I’m comfortable with this level, I don’t want to go beyond this. But I’m going to get better at this level. And then when you start to find a niche is that that bubbles just automatically start to grow as you think to yourself, Well, actually, I am seeing enough patients to be able for me to warrant doing sinus lifts and learning about them and adding them to my to my feet. Because you know, I’m having to refer three or four hours a month, then that’s obviously a different ballgame. But don’t don’t be afraid to start the journey. But just don’t also be naive to think to yourself, this is a this is an issue jazziz. Because the way that I look at it is how many courses would sell is if the people who are running the courses turn around and say to actually no, we’re going to charge you X X amount, but by the time you get to the end of it, you’re only going to be able to do the really simple cases, you know that what, there’s a little bit of embellishment, I’m not saying people are being malicious about it. But people want to run these courses. And these courses are sponsored by implant companies. And these implant companies, they’re gonna want you to buy their implant systems, there’s pros and cons to each implant system. You know, you need to understand what you’re buying, and make sure that you understand the data, so that you’re comfortable with it. You know, I did a podcast with Bill Schaefer a few few weeks ago, this is one of the things that we were saying, there are some really crappy implant systems on the market. There are some good implant systems. And there are, there are certain important systems, which I know are good, but it doesn’t fit in with my working style. So the implant system that I’ve used, I’m comfortable with it fits in with my working style. And in addition to that, I’m happy with the data, the scientific evidence behind it as well. So you’re absolutely right, there is so much to it.

[Jaz]
It’s really overwhelming. I just found whenever I’m looking at you know what I’m thinking is it time to to move up the gear and the implant stuff. I just get totally overwhelmed. Come visit the Avon hang around the corner, man of course. Yeah.

[Pav]
Yeah. spend the day with a well sorted out. But he’s like, No, you don’t have everything’s overwhelming. You know, it’s overwhelming to me. And no, on any level whatsoever. He’s overwhelming, no else is overwhelming to me. Because Because I’ve not done them for such a long time. Now that I do. That’s a that’s a feel stretched such channels in implants. And I deliberately made them a different color, so I can see them in case I ever need to retrieve it at a later date. So we can’t be professional at everything. Don’t think we can do professional, everything you know is is we can have a very good abroad subset because we keep going back to this super GBP. One, they are considered super GDP, Roger Ahluwalia, he does some absolutely beautiful, beautiful work, okay, he sends us work to do here, because he’s just like, not the set up. But you guys have got there. This is just like my patients are going to be better off going there. So you know, it’s Don’t be afraid. And don’t be worried about saying to yourself, here’s my limitation. I’m going to study to expand that. But also, if you say to yourself, here’s my limitation, I’m not happy with that, because I want to do other things as well. That’s absolutely fine. And don’t let anybody tell you your power cannot do something. You know, it’s you’ve got to always put the patient’s interests first. But it’s a continual learning curve.

[Jaz]
Amazing. Have you got time for one more question path? Yeah, absolutely. Okay, so my last question is, if someone wanted to start their implant journey, maybe they’re two, three years qualified, that found their feet a little bit the progress enough that they want the next challenge? Is it right, this whole mantra of learn how to restore implants first? Or do you think they should be actually learning how to do the surgical aspect as well as same at the same time as doing the restoring what what is your beliefs and thoughts about this, that when is commonly abandoned around about learn how to restore an implant first, then progress? Is that the right way? In your opinion,

[Pav]
you don’t necessarily have to be able to proficient at restoring implants first, but you need to understand the restorative process first. Okay. So there’s two things that I would say to that the best implant surgeries that I’ve seen, understand restorative, the worst implant surgeons I’ve seen, do not understand restorative. Okay. It really is that simple. And the other thing that a lot of people ask is, why is there no speciality in dental implants? Because it’s too large and too complex the field. You know, if somebody turned around and said to you, right, we’ve developed a specialist training pathway. This training pathway is 15 years old people gonna go Forget it. I’m not interested. But what a lot of People start to discuss when they when they start to become professional implants, is implants is a restorative is a prosthodontic process with a heavy surgical element that makes sense. So they are putting, they’re putting the restorative first. Why is that? Why is that important? Just because patients don’t want implants, they want fixed teeth. That’s more important. And the implants are just a method to achieve that. So understanding the restorative process is critically important. There is no reason why you can’t learn the restorative and the surgical at the same time. But don’t make the mistake, I’m just going to go down the surgical route because we’re not being your patients.

[Jaz]
And what do you think about this whole concept of young dentists who can’t section and elevate, then going on to an implant course, like people who just can’t extract teeth provisionally starting surgery, because that happens a lot, I feel,

[Pav]
yeah, you’re gonna, you’re gonna get your fingers burned. And they’re gonna be expensive mistakes, you need to start to, you know, whether it’s at your local hospital goes, you know, get a part time job, raising flowers, removing wisdom teeth, taking out broken teeth, you have to have those surgical skills, okay? If you can’t take out teeth, a traumatically. All that, all that’s going to happen is you’re going to get your fingers burned. And you’ll get one of that patient’s breathing down your neck. So patients are going to come in, we’re going to say, right, so why does this implant? Why is it taken, or what you’ll do is you’ll start a process and understand it’s way more complex than what you thought it was going to be. And all of a sudden, you don’t have the skills to be able to help that patient. You need to understand that restorative process, you’ve got to start to build your surgical skills as well.

[Jaz]
Amazing. You’ve raced through all my questions, but you know, it’s easily been 45 minutes easy, very easy talking to you. I think we’ve covered so much there. I think me and you’re both naturally quite fast talkers lend ourselves to podcasting and stuff. So I think there’s about there’s about 90 minutes of content in this 45 minutes, I think. So I think that’s been a really good path. Thank you so much for your time to share. How about how your journey of niching down I think it’s gonna inspire a lot of young dentists who maybe think that I don’t know how to go about this or that maybe they’ve left it too late. And I think your your story is sensational. So thank you for sharing it with us.

[Pav]
Thank you jazz for, you know, encouraging me to get into podcasting and I’m really enjoying it as well doing

[Jaz]
great things you’ve had great I mean, just the other day I listened to Paul homily, one communication, your your your natural path, your natural and I’m enjoying it. And I think for those people who really want to learn more about implants and or you’re already an implant geek, then you know, paths podcast is the podcast to go to. So do check it out, hit that subscribe button. And let us know we thought this episode when it’s out. And similarly, anybody

[Pav]
listen to my podcasts, please look at jazz as well, because he does a lot of great stuff not just focused just on implants, but on general dentistry. And it’s the protrusive Dental podcast, so jazz, etc. You know, this is great seeing your career progress from from, you know, when I first made a few years ago, I’m very happy for you. I’m very proud of you as well, I think you are also a very good example of what passion can do for dentistry. So you know, it’s when people just chase the money is they’re going to they’re going to they’re going to end up unhappy long term is that you’ve got you’ve got to be passionate about what you’re doing that that obviously comes through in everything that you do.

Jaz’s Outro: Thank you guys for listening all the way to the end. I hope Dr. Pav Khira brought some value to you whether you’re considering dabbling into implants and you hear that will kick up the bum to get started. Or maybe you resonated with my story about hesitations about giving more time to implants because it might mean that you are having to focus less on other areas of dentistry which you enjoy. So I’ve actively made that decision to not dabble with implants or to not get into implants because I feel as though that it’s such a huge steep learning curve. But I do feel off that chat with Pav today that perhaps there is a role in learning how to restore implants first and go follow that sort of pathway to be able to provide that service to your patients because implants is just dentistry. It’s another part of dentistry is on the tool. If you enjoyed this episode, then do check out the dental implant podcast by Dr. Pav Khira. And just a bit of news for you. So many of you joined the whatsapp group that we’re kind of full. And I’m really gutted for everyone who didn’t join the whatsapp group because we’re getting messages all the time now saying hey, what happens to whatsapp group is full. So we’re starting a telegram group, which apparently has a lot more capacity in a group. So I’ll keep you posted on that do join the protrusive Dental community Facebook group to get updates for that. Now the second bit of news I have for you is for those of you who’ve been messaging me about when we’re taking the next cohort of splint course delegates. Well that’s happening on the seventh of June as it stands. If anything changes I’ll let you know but as it stands it is seventh of June and all you have to do to sign up is splitcourse.com just leave your email address. And so when I’m ready to launch, I’ll email you. And this time it’s gonna be a two week window, and I guess I’ll email you all the different bits of information about what this course entails, the monthly coaching, the Facebook group, the case support, the handouts, everything you need to know for it. So if you’re interested in Split course and you missed out in the first cohort, do check out splintcourse.com register or DM me on Instagram @protrusivedental, and I’ll give you some useful information from there. Anyway. Thanks so much, and I’ll catch you in the next episode. Same time, same place.