The Business Of Implants In 2026 with Dr Pav Khaira [CPD Available]

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If you’ve ever wondered why two clinicians can place the “same” dental implant but get wildly different long-term results, this conversation gets to the heart of it. We sit down with Dr Pav Khaira, founder of the Academy of Implant Excellence, to unpack how biomechanics, diagnostics, and patient communication combine to create predictable implant dentistry that is faster, safer, and more profitable per unit time. 

We talk through the practical decisions that quietly drive success: structured diagnostics that remove uncertainty, sinus lift planning with an honest view of difficulty, and defect classification so regeneration choices are deliberate. Pav explains why biology and even the boring parts like histology matter, because healing happens at a microscopic level whether we acknowledge it or not. Stack enough small “marginal gains” and you reduce complications, post-op issues, and remakes without adding chair time. 

On the biomechanics side, we get specific about implant axis, horizontal position, depth, connection type, diameter, occlusion, and why vague lab scripts like “screw retained crown please” can store up problems. We also dig into the human side: listening to anxiety, avoiding pushy sales tactics, recommending implants ethically, and building trust strong enough that patients refer friends and family. We finish by linking clinical skill to financial freedom and why IV sedation can be a game-changer for uptake and patient experience.

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Disclaimer: All content on this channel is for education purposes only and does not constitute an investment recommendation or individual financial advice. For that, you should speak to a regulated, independent professional. The value of investments and the income from them can go down as well as up, so you may get back less than you invest. The views expressed on this channel may no longer be current. The information provided is not a personal recommendation for any particular investment. Tax treatment depends on individual circumstances and all tax rules may change in the future. If you are unsure about the suitability of an investment, you should speak to a regulated, independent professional. Investment figures quoted refer to simulated past performance and that past performance is not a reliable indicator of future results/performance.

Transcript

Why Implant Efficiency Matters

Dr James 0:00

We're here today to talk about implants and specifically how we can be efficient with both our patient outcomes and also our work time, which naturally leads to better outcomes for all involved, both in terms of patient satisfaction and also in terms of profitability per unit time. I'm joined today by Dr. Pav Khaira, who knows this stuff inside, but Pav is able to achieve a great deal of success whenever it comes to patient satisfaction and all the things we mentioned just a second ago more will be revealed as this podcast progresses. As ever, you can claim your CPD for this episode within the official Dentists Who Invest Smart Money Members Club. Smart Money Members Club also includes multiple mini courses and webinar series on finance for dentists, including how to become as tax efficient as possible, as well as understanding investing. All of this content counts as verifiable CPD, and you can download your certificates there and then upon completion of each lesson. In addition to this, we also include a whopping 10% discount on your dental indemnity and a 5% discount on lab bills for dental principals, amongst other perks and discounts for members. Please use the link in the description to claim your verifiable CPD for this episode. Dr. Pav, how we doing today, my friend. Both of us are riding high off the back of the Business of Dentistry conference over the weekend, which was fun. Uh, I must say, there was uh 400 dentists in the room in the end, which is really cool, and a lot of people there who were very interested in learning about how they can take their careers to the next level, which is obviously pertinent because whenever it comes to the implant side of things, well, that's your bag, really, isn't it? That's my jam. That's my jam. He's owning it. He's owning it. And and fair play, because you should mate, because what what you've done is amazing. And Pav, I gave a little bit of an intro to you at the start of this podcast. Maybe it might be nice if you just told us who you were a little bit.

Dr Pav 1:58

Yeah, not a problem. So, uh, as a lot of you know, uh, my name is Dr. Pav Caro. I am the founder and CEO of the Academy of Implant Excellence. And I have uh I train and mentor other dentists, and I have a quite a specific philosophy, and that philosophy is um patients always come first, and you should know your stuff inside out. Oh, yeah, and if you know your stuff inside out, and you've got good skills, and you're looking after the patient, the business just rolls by itself. I I feel a lot of people have that backwards, and I also feel that a lot of people um are not trained to a high enough standard. And this this is kind of like fallout from when I did my uh end as well. Either got to the end of it, I was just like, I didn't learn a massive amount, and that's when it kind of like started to dawn on me that actually, you know what? MSCs are not designed to turn you into an expert, they're designed to give you theoretical knowledge. And the issue that you have is uh implants, you need theoretical knowledge, but you need

Meet Pav And His Philosophy

Dr Pav 3:10

hands-on experience as well. You need exposure to both. And once you start to build exposure to both, that's when uh that's when business changes, just transforms. And uh the more that you understand about biomechanics, there are two things that end up happening. Firstly, uh, you have fewer problems. Now, I'm not gonna stand, I'm not saying I'm not gonna stand here. I'm actually I'm actually sat down. I'm not gonna sit here and turn around and say, I don't have problems. I do. That's the nature of what we do. Okay. But I would also say endodontists have problems, orthodontists have problems. That's the nature of practice. That's why we call it practice. But the as much as we can reduce those complications, the better. Okay. The other thing that we can do as well is when you can do stuff that other people deem impossible, and you can do it predictably, then patients want to come to see you because your treatment plan is four months long, and next person's treatment plan is 18 months long, and patients is just like, why should I wait 18 months for the outcome when I can have it done in four people? And that comes from genuine understanding of of biomechanics, and and and I say a lot now as well. I say, look, if if if colleagues understood the impact of having an implant slightly off axis or slightly malpositioned, quite simply they would they would do 100% of their cases guided. And it's not just that, the number of times that I see people when they send a prescription to the lab and they the prescription is screw retained crown, please. That is wholly inadequate, and you are potentially without knowing doubling or tripling the forces going through your implant, which can lead to biomechanical failures in the future. So a lot of what I teach, whilst I teach in depth, the implementation of it is very, very simple, very straightforward. And that is my philosophy. That's what I've that's what I've always pushed for, that you need to know your stuff biomechanically in depth, in order to achieve the best outcomes for patients. That's what I love.

Dr James 5:37

And you know what? This is this is the good stuff right here because as someone who's walked the walk and got to where you have, and now I teach dentists whenever it comes to implants. You believe that now you look back when when you when you have that, when you have that, when you go on that journey, you can see things from a bird's eye perspective, right? And you're like, oh, okay, not only do did you do what was required to get there, but you now understand the importance and relevance of each specific thing and how much weighting to give it, okay. And that's why that's so valuable, right? And it's the same in business, you know, someone who's got to 10 million in terms of a dental practice, does you know, it's not that they work harder, it's just that they know what to put their energy into a lot of the time or what to focus on, you know. And that's the thing that startles me, it's just being able to see those things. But anyway, with relevance to this conversation and the implant side of things, you're it from what you observe throughout your career, biomechanics is the the key differentiator between someone who does implants and someone who does implants superbly and efficiently and uh to the to the highest possible standard leading to really great patient outcomes. Yeah, absolutely. If you were to pick that, if you were to pick one thing, it would be that.

Dr Pav 6:48

Yes, yeah, that that that and the BA and the ability to be able to communicate well with patients. I think that is I think that's grossly, grossly underestimated. Because it doesn't matter how good your technical capabil capabilities are, if you don't know how to listen and communicate with patients, that that is then they're not going to want to see you regardless anyway. You know, I a lot of my patients go ahead with uh treatment because uh not not not because I'm doing the treatment, but because they feel listened to. You know, there might there might have been to see two or three dentists already, and uh the dentist uh hasn't really addressed the fact that the patient is extremely anxious. You know, it's just a matter of, oh, you'll be fine. And the patient's like, I'm the one that's having it done, you're not you. It's easy for you to say you'll be fine. Whereas, you know, just gently approaching the patient, you know, asking them, just say, Look, what what's making you anxious? What what what what's put you off dentistry in the past? What are you worried about? And then, you know, just at that point, shutting up and letting them talk. Firstly, let them get it off their chest,

Biomechanics As The True Differentiator

Dr Pav 7:55

right? And then it's not a matter of um uh uh it's not a matter of answer their objections. I don't like that sales technique because it doesn't work well, okay. Um there's this whole thing, it used to be, oh, find out what their objections are, answer their objections, and then all of a sudden they'll have no objections and they feel like they have to go ahead with treatment. That's not ethical, that's not the right way to do it. The way to communicate with patients is quite simply is to give them reassurance and not be pushy. You know, I've got some patients where um, you know, they don't they they don't understand the power of sedation and they're like, no, I'm only having this done if I can uh have it done under general anesthetic. And I've got a couple of patients who are prepared to who've already had treatment done under sedation, just as anxious, prepared to speak to these patients. So I turn around and say, How about I get you on a phone call with this other patient? So you're not hearing it from me. I said, at that point, if you decide that you still want to have it done under general anaesthetic, you understand I can't do anything for you because I can't do it under general anaesthetic. So it's addressing the patient's concerns as well. And the reason why I say this is because this, you know, we're on the uh uh you know, we're on the dentist who who invest for them, and you know, this is about business. And in order to do business, you have to be able to communicate with patients. So biomechanics is one aspect, and the other aspect is is purely communication.

Dr James 9:26

You know, that has great value to be able to isolate the two most important things for other clinicians that are out there, and communication is a recurring theme, it always comes up. And the you know, I was on a course once, I don't want to I don't want to steal the limelight here, Pav, because I want to get into what you know, not what I know or my journey or whatever. But I remember I was on a course once and it was a communication course, and the uh presenter, the person who's running the course, he wanted to make a point, and he was like, Okay, cool. What I want you to do, guys, is I want you to all write in a piece of paper how good you are, how good you think you are at communication out of 10, all right. And he's like, Bear in mind five should be the average in this room, guys. The average is being reset for this room, not relative to the rest of society, relatives of the dentists who are in this room, so therefore the average should be five, it should be a bell curve, right? Uh, and he basically took all the bits of paper that everybody wrote down anonymously and he tallied them all up, and the average was like 8.3 or something like that, right? This is the thing, we all think we're better than we are, right? But we should it should have been five, right? And he was like, use that as your yardstick. The average tent is five, where do you think you are, right? And um, it's almost like a little bit of an ego blow for some of us to be told that we could be better at communication, right? And I certainly felt like that. I was like, I know how to talk to people, uh, but you know, back in the day in 2017 when I qualified, all my patients took the NHS option, right? And that was a hundred percent how I was framing it to them in the rear view mirror. I just didn't know it at the time. Uh so I guess the reason I'm sharing that story, and then by the end of the course, just to run that story off, he was like, Okay, now I want you to go back and rate how good you were at communication, or good, how good you now believe yourself to be, or how good you uh thought you were at the start of this day, uh, relative to how you now believe you are at the end in terms of your skill out of 10. And the average was like 5.2 or something like that. You know what I mean? People kind of saw the light basically. Uh but yeah, anyway, it's an interesting, it's kind of like almost like a little like mild delusion that we all suffer from that we're we think we're really smooth at it. But actually, the reason I tell you these stories is not because to to diminish anybody, but more to say let's be open-minded. That's all I'm saying. So you know what? Let's focus on biomechanics. Because I know that you've just said that this is the key differentiator. What specifically should implant dentists know or do or be aware of in order to enhance their treatment outcomes, their efficiency, and then therefore their productivity

Communication That Calms Anxious Patients

Dr James 11:55

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Dr Pav 13:47

So I I I I I think it falls back to a number of factors. And uh if I forget, remind me about this bit a bit later on, but um companies sponsoring courses. I want to come back to that bit a bit later on. Okay. It's it's it starts with diagnostics, okay. If you have good diagnostics, the treatment plan almost writes itself. Okay, if you don't have good diagnostics, you end up with a little bit of oh, what should I do? I'm not sure. I'll give this a crack. So actually, your um uh your uh uh your treatment plan from the staff from the start may be compromising, you don't even understand, you don't even know that. So, for example, let's take for let's take, for example, sinus lifts. Okay, a lot of people like, oh, I'm gonna do a crustal sinus lift, I'm gonna do a lateral sinus lift. Why? What's your reasoning behind it? Okay, what where where did you draw that? Where did you draw that line? Where did you draw draw make how did you come to that decision? Is this gonna be an easy case or is this gonna be a difficult case? You know, what biomaterials are are you going to use? Now I see people doing these massive, massive, massive sinus lifts, and then uh putting very poor quality biomaterials into the sinus, then having complications, and then wondering why they had complications. For example, there is something called a maxillary sinus elevation difficulty score, the MCED score. Okay. Now, most people who do sinus lifts have got no idea that this even exists. Okay, so they are executing a sinus lift without understanding the difficulty of it. Okay, and there's different difficulty levels. And if it's your first sinus lift and the score tells you this is a difficult sinus lift, are you sure that's the one that you should be doing first? So this is what I'm expressing is you know, it comes down to diagnostics, and this is and and and this is true of everything. If you have a defect where you want to

CPD And Smart Money Members Club

Dr Pav 15:50

uh where you need to regenerate the bone, then you need to classify that defect. If you classify the defects properly, you know exactly what will and what won't work. And I'm I'm very, very um adamant on my delegates about this. You know, I give them proformas to help them diagnose because I can't remember off the top of my head, you know, I I need prompts to remember what I should be doing. So if I need to do that, my delegates need to do that as well. So first and foremost comes diagnostics, okay, then comes uh understanding biology. And I don't mean, oh, if you cut somebody and stitch them up, they'll kind of like heal together. Okay. Or I don't mean, well, this kind of works. You need to know macroscopically what's happening and microscopically what's happening. And as boring as histology is, and I know it's boring, it's also the it's it's it's also the key of what we do because everything happens on a histological level. The healing cascade is on a histological level. So actually, if you know what the healing cascade is and you know what influences at at different stages, you can manipulate that healing cascade. And if if you can manipulate it for the better, that also means if you're not aware of it, it can work against you if you don't know what you're doing. You know, it's you know, it's I I have I have people turning around saying to me, I use these sutures. And I turn around and say to them, Why? And they don't know. Oh, it's just what I was taught to use. It's like, are you aware that if you change your suture type, your soft tissues will respond better? So this is why I'm expressing that actually, you know what, understanding biomechanics doesn't make your treatment plan more complicated. Sometimes it's it's the simple things of just switching your your suture materials, and you switch your suture materials and all of a sudden your soft tissues look better. So all of this starts

Diagnostics That Write The Plan

Dr Pav 17:45

to add, it starts to stack on. So we've probably all heard of um uh uh marginal gains concept, and this is the uh coach of the uh Great Britain cycling team who uh the and the Great Britain cycling team was a uh uh you know that they were they were considered pretty much useless, and within a very short time frame, they ended up being world class. Now, apparently dopings come into that as well. But that aside, there was there was other things that that that that that came into play, and it was from this coach. And this coach was like any single gain that we can potentially get, he's gonna get. So he insisted that all cyclists shave their legs so that there's less air drag from hair, you know, and all of these little things add up. And I have the same mindset, and I've got other friends in in the implant field who they have the same mindset as well. It's like, okay, you know what? It may not make a massive difference, but if it takes a small difference and I've got 50 of those things making small differences, maybe, maybe I'm 15, 20 better than if I didn't do that. And 15, 20 is all of a sudden huge. Now we're not talking half a percent, we're not talking one percent. Now we're talking about much, much bigger gains. And we also know as well that once you understand um biomechanics and biology, this is also when you can start to do stuff that other people deem to be impossible. So, for example, a lot of people turn around and say, if you don't have a thick buckle plate, you can't do an immediate implant placement. That's a load of nonsense. You can. There are plenty of techniques out of out there which teach you how to do this, and they've got good data behind them. So actually, if you're saying that there's no buckle plate, I can't do an immediate placement, all you're telling me is I haven't read that that that that literature which which shows me how to do it. And then what ends up happening is people are people are not taught to think biomechanically, people are taught to think in terms of process. And that that really winds me up because I don't like it. Because when you understand biomechanics, the process becomes evident by itself, and you know when you this is when you can start to be smart, is think to yourself, well, you know, normally this would take me six appointments to get it done. I can do it in four and actually get a better outcome. Patient's happy because they're not not more trips to and from uh uh away from work, away from home. They get it done in a shorter time frame, less chair time for me. I'm happy. And so this is why I said right at the beginning that actually when you understand biomechanics and you look after patients, the business comes by itself. I guarantee you, if you put the business first, is at some point you will be tripped up. You won't know what happened, you won't know how to fix it, and uh things start to unravel from there. So the sequence is understand biomechanics, which starts with uh diagnostics. Once you have your diagnostics correct, uh you then need to if you've got enough depth of knowledge, you then start to think, I can do this, I can do this, I can do this. And that's when it starts to get really fun.

Dr James 21:10

I love it. And you know, why do I get the impression we're just scratching the surface of what you know whenever it comes to this stuff, Cab? I'm sure there's plenty more in that front. And you know, just to jump into that, actually, um okay, we've got the diagnostics, we've got those in the bag, those look really good. Okay, and then procedurally, you you you hinted at this earlier. Um, procedurally, there's things that we can do in order to enhance our outcomes that you suggest should be common practice, but they aren't always. You hinted you hinted at one earlier, and that was using uh guided implant placement. Yeah. So that's a biggie for you.

Dr Pav 21:46

So for me, uh you don't necessarily have to go guided, but if your implant is uh if your implant axis is off by even 10 15 degrees, it has a massive impact in the force through the implant. abutment interface so if you've accounted for that uh or even or even if it even if it is at the correct axis but it but it's off horizontally so it's too far like in a molar position that actually is perpendicular but it's too far close to to the to the adjacent teeth and you've got like a bit of an overhang on on the crown that also uh increases force through the uh implant abutment interface and through the screw so all of this can have a problem so when people turn around and say you know I've had screw loosening it's like look did you use the same screw that came back from the model you know what what were your disinfection protocol what was your disinfection protocol what's the diameter of your implant what's the connection type of your implant okay because all of this plays a role what depth did you put it at you know we we should not be getting any bone loss around the margins of the implants as well so there's two different types of bone loss type one is called marginal bone loss the second one is marginal bone remodeling the difference between the two is quite simple marginal bone remodeling is I put the implant in the bone goes to the neck of the implant so it remodels to the neck of the implant and it stops okay marginal bone loss is when you put it in you come time to restore and it's down to the first thread. So you've lost the bone you've not remodeled it to where you wanted it to be you've lost the bone and that comes purely down to biology. So if you're having bone loss around an implant neck before you've even restored it that's inadequate inade inadequate biomechanical knowledge right there. So all of these things start to add up yeah I've I've already expressed before as well that occlusion on implants is completely different to occlusion on teeth. So if you're giving the same occlusal prescription on an implant as what you do would do a natural tooth you're potentially introducing complications further down the line. So this is why I'm saying is uh and and do you do you see what I'm talking about here now James is is that this level of depth of knowledge is not increasing chair time it's doing simple things like changing the depth of an implant at time of placement it is choosing a certain connection type certain diameter writing certain things in in the prescription so the chair time is the same or less but your outcomes are vastly different. This is and this is why I'm I'm so passionate about it.

Dr James 24:30

This is why I believe that we should be understanding this on on on so on such a depth yeah I mean it's it's the the reason why this is mainly so important is to get the b the best outcome for the patient and everything else flows from there. Yeah so here's the second thing that happens you get all of this right less chair time what do we want as you get less chair time less pain uh less fewer complications uh uh uh fewer remakes all of that good stuff all of that good stuff greater efficiency which is good for everyone on every level there's no downside to that yes no downside you know there's not even a sacrifice in terms of speed versus outcomes they're actually synergistic it's actually both these things and it comes back to knowing the stuff that you've said and this stuff uh do you believe that they go to this level of detail in your typical masters I guess no no and how do I know that because several of my delegates have got master's master's degrees and they all said the same thing they all said look I was taught the basics pretty well but I thought I would be an expert in everything by the time that I graduated and I turned around say to them that you're not alone because I thought the same as well. And this isn't this isn't having a go at master's degrees this is this is reframing it right that everybody's assumption when they start a master's degree is is is twofold firstly you will be an expert by by by by the time you come out and secondly

Biology, Healing, And Marginal Gains

Dr James 26:05

patients actually care about these letters after your name and the answer to both of those is no not really you know you said something really interesting once and I always meant to ask you about this and I feel like it's relevant to this conversation so let me ask you now I remember we were talking once or perhaps you were possibly speaking in front of a room as well and I remember you saying this and we were talking about the the uh career path of an implant dentist right like if you want to uh propel yourself or you want to progress further down that path right so it starts out single tooth multiple tooth then maybe all on four or something like that you know what I mean and again it doesn't look like that for everybody but okay that's your typical progression and I remember you said something really interesting and you said you know what I used to think all on four was a pinnacle but now I know it's not even close.

Dr Pav 26:57

Yeah what did you mean by that I mean it it is such a varied and diverse field is it's kind of where it's it's it's like where do you stop right so you go from uh you go from all on four to uh and and then you split it down are are you talking uh uh fp3 type uh prosthesis which is your typical what you see all on four or are you talking like uh FP1 uh prosthesis which is basically just replacing the teeth okay then there's like okay well um I can't get the implants in the right position uh we need to start doing pterygoids then you get good at pterygoids then you need to look at transnasal implants then you start looking at zygomatic implants then you start looking at subperiosteal frames and once you can do all of that you know what your favorite case becomes that single implant out of the smile where there's plenty of bone and you know it's going to take you five minutes to do. So that is the full circle that is the full circle you constantly want to be I want to be able to do this complex work. I want to be able to do this complex work. In order to do the complex work you have to be able to deal with the fallout part from it as well. And again on that full arch thing and this again goes back to diagnostics treatment planning and understanding everything is there is a disgusting overuse of FP3 where people are just hammering the hell out of the boat.

Dr James 28:25

And uh it's it it it is it's easy it's easy right the other way to do it yes there are fewer cases where it can be done but even in these cases where it can be done the uh the the the technical need from the surgeon and the technician jumps significantly so it's almost a case of damned if you do and a damned if you don't because on one hand you have an easier treatment plan but it's extremely destructive but on the on the on the flip side of that coin is you have a much better outcome and treatment plan which is technically more demanding for you and your technician and the truth probably lies somewhere between in between you know we're not Sith we don't deal in absolutes the the the truth probably lies uh probably probably lies somewhere in between but then this goes back to if you know uh biomechanically what you should be doing you can make the appropriate decisions you can make the appropriate outcomes that's what it comes down to let me see okay interesting just processing that yeah fair enough fair enough and um I don't know I'm I'm actually I'm actually a bit disappointed in myself that I didn't get that star for Star Wars reference right there the the Sith dealing in absolutes I must have I must have missed that part of uh of Star Wars uh but uh yeah anyway maybe maybe that's a feature kind of a recurring theme of the the Sith versus the Jedi I don't know I didn't know that one but there you there you go uh but yes anyway no um thank you for that pal thank you for shedding light on that and you know I also wanted to touch upon communication given that that's so important as well to all the things that we mentioned earlier in this podcast I know that you mentioned that a lot of the time dentists aren't doing the basics like addressing the elephant in the room like why the patient is in a certain emotional state whenever they come to see you and often the patient can't really they almost are not even aware necessarily of why and you you can't just say why are you anxious right you just have to say you can say something like what's going through your head or was there a particular occasion in the past that made you feel a certain way or kind of put you off being a dentist or I don't know. You know something like that. The key thing I understand is

Guided Placement And Avoiding Failures

Dr James 30:55

the patients they don't always know why they feel a certain way right so that's an example. And then can you think of any other methodologies or practices that you have whenever it comes to communication that seem to facilitate you doing really great implant work. Specifically with regards to uh anxiety or or relating to abuse I think you know what I think generally and I think things that how can they say this almost like if you observe other dentists which I'm sure you do through your mentoring okay and their communication styles like maybe frequent clangers that they drop that you that you don't do or things that you feel that if they address these things they'll all of a sudden just become so much more smoother whenever it comes to their patient interactions.

Dr Pav 31:42

So I've so I've I've I've got a couple of good ones so first having confidence in yourself nice which goes back to understanding biomechanics properly okay um but quite often what happens is when dentists start talking to a patient who needs to have a tooth removed the way that they approach it is oh once you have a tooth removed you can leave it as a space you can uh have a denture a denture comes in one of two forms you can have something acrylic which comes in and out you can have something with a metal substructure you can have a bridge a bridge is fixed in your mouth it uh uh but you need to it requires preparation of the adjacent teeth and then almost flippantly at the end oh you can also have an implant okay firstly that hierarchies backwards okay from forgetting patient anxiety forgetting for forgetting patient desires forgetting fun and money all of that okay purely from a biomechanical point of view once a tooth is removed the next best thing is is an implant end of discussion everything else is one step back from that okay or several step backs from that and the patients need to understand this if they don't want to have an implant done that's absolutely fine the other thing that dentists mistakenly think as well they mistakenly think that we cannot offer treatment recommendations to patients which is a load of nonsense you are medico legally uh permitted to say you know you need to have this tooth out there's nothing better than having an implant put back into its place. The pros and cons of implants are this here are your alternatives that's it that's what it comes down to. So I actually turn around and say to my patients that you know um uh purely from a biomechanical point of view I know that this isn't in the corner of your smile but it's an important chewing tooth you don't have to have it replaced but my recommendation would be that you have it placed there's the you know can you see there's a difference in that discussion and then the other thing that I see as well is is people turn around say um oh I want to get started in implants but there's not that many implants in in in my practice is we just we just don't do them. I turn around say to them how many teeth do you take out per month oh between 15 and 20 like right how many of these patients are you telling they would benefit from them from an implant oh I'm not telling them there's your problem there's your problem you know if you if you if you've got good communication skills and you tell 20 people uh uh in uh who are having the tooth removed yes I know some people can't afford it and there are certain practices uh where the demographic don't fit but in your average practice either a private practice or a mixed practice a lot of people will go ahead but I'm not recommending patients um uh to have treatment done um purely for my for my own wallet I'm doing it because I genuinely believe it's in their best interest I had one gentleman about six months ago uh elderly um his teeth are falling out from period uh he's had simple dentures before in the past absolutely hates them uh he told me he has the funds for it he has the desire to do it um he was a little bit anxious but I thought we can sedate him that'll be fine but then he said something to me and I refused to do the treatment for him and he expressed concern that his wife's health is not as well as what it should be and she may need that money in the future to be looked after. And I quite simply turned around and said to him you know what I don't think this is the right thing for you to do because if it was me in that situation I wouldn't want to do it. So my recommendation to him became look there's a handful that there's a handful of more teeth that need to be removed. Have a really nice set of dentures made if you don't get on with them come back to me

Beyond All On Four Thinking

Dr Pav 35:45

because then we have more options. I said but if you do get on with them fine that we you don't need to have anything further done so whatever we recommend to patients have has to be in their best interests. Now a lot of people will turn around and say well you're shooting yourself in the foot pav because you know you could have done a really big goularch case and that would have been good income. Yes it would have been okay but what I would rather happen is I would rather be him be out turning around saying to his friends and family oh you need to have a two three go see Pav because he'll give you an honest answer. And honesty is it's it's it needs to be uh further for uh on the forefront of what we do as well because without that honesty aspect you know it's with with my communication skills would have been easy to get convince him to have the treatment done would it have been the right thing for him purely from a dental point of view yes but fitting it into his life and the other stuff that had that he had going on wouldn't have been the right thing to do. It would have been unethical of me and I I didn't want to do it so I actually refuse to do his treatment so this is where communication comes in uh that we need to be able to have these commun that these discussions with patients and if you if you have these discussions with patients and if you're good at communicating your biggest problem is going to be I don't place implants or I can only place the basics I need to have more training to do the more complex stuff you know you don't have to become um purely uh an implantologist okay um that that that's what I do okay I've got a handful of dentists where uh sorry I've got a handful of delegates where that's all they do they do implants they do they they do nothing else but 95% of my delegates they're actually general dentists and they wouldn't want to step away from the general dentistry side because they enjoy it too much me I don't like it I'm not interested in that the so I stick to just the just the just just the implant side so everybody's career and pathway and progression is different and we need to respect that but whether you're learning implants whether you're learning endo whether you're learning ortho you should be passionate about it enough that you will never stop learning I still learn I'm going on courses this year I have my mentors that will never stop uh uh uh never that learning will never stop for me and I believe that we should all kind of like be the same in in what in whatever field we want to do even outside of dentistry if you're in another profession you should be passionate about it because the the more knowledge you have the more skills you gain the more you can do things that other people cannot do and you end up being in a position where you have less and less competition that's the way that I look at it.

Dr James 38:45

Yeah 100% and you know you know on that actually obviously this is the Dennison Invest podcast and people come to me all the time and they're like okay cool how can I be financially free and definitely investing is part of that. Like obviously you want to have your pension and your ICIN and everything along those lines but what actually generates funds for the pension and the ICIN in the first place yeah what's your great you have two levers you literally have two levers when it comes to your investment portfolio you can either boost returns or you can boost contributions. Those are your only two levers. There's literally one of those two things and returns is a function of the return of the investment the appreciation of the investment manage the fees right so obviously you reduce the fees and you boost the appreciation of the investment. But when you know a little bit about the stock market and when

Ethical Recommendations Build Trust

Dr James 39:35

you know a little bit about investing I mean it's very hard to beat the market it's very hard to beat the S P 500 okay it's like is you know most funds managed by professional managers fail to do that. So the odds of you doing that are really slim like 3%. I think it's like 3% of active funds beat passive funds okay and those are professionals yeah so what I'm saying is that when you realistically you're only going to really max out around the level of returns of the SPs the S P right so that's the most that you can ever boost your returns. Therefore you have to look at the other lever which is how can you boost your contributions and what literally puts money in the investment portfolio is your skills. And people don't get that enough if you ask me I personally believe that if you really want to accelerate your wealth journey you should look at your cash flow and where that comes from and part of that is being able to do really high qual really specialist work because obviously it carries more of a premium but also really high quality and really efficient which is actually exactly what this podcast is about. And honestly I feel that if people got that and embraced it that a lot more rather than continuously looking for an investment edge they'd probably get to where they want to go a lot faster.

Dr Pav 40:44

It's a mindset thing as much as an absolutely yeah absolutely agree and uh another aspect on top of what we've been discussing as well is um you know uh Ivy sedation you know quite simply is it it if if patients want to have implants done they will be anxious about it um even if to me I know it's going to take me five minutes to place this implant for the patient they're like well I've had a filling done before I've had a crown done before but he's talking about drilling into my skull and psychologically they can't handle that. Well actually I can do it under IV sedation you'll be away with the fairies you won't have the you won't have a clue what's going on. Okay great now I'll have it done. So actually if you do a significant amount of of surgery and uh and implants I do believe IV sedation goes hand in hand. And then what happens is once you have that skill you don't have to limit it to just surgery you can roll it out to general dentistry. You know IV sedation is a fantastic and extremely powerful tool.

Dr James 41:48

Knowledge has been dropped on this podcast today. Thank you Dr. Pav Pav if anybody is listening to this podcast and they want to find you and talk to you about anything that you've mentioned today where are they best off where are they best able to do that?

Dr Pav 41:59

Yeah so uh if you're uh somebody's interested in the academy it's very simply academyofimplantecellence dot com. Uh you can find me on Instagram dr dot pav uh dotkera uh there's academy of implant excellence uh instagram uh handle as well so uh lots of ways to to to to to to get hold of me and and get in touch with me uh what I wouldn't say is uh those who join the academy they tend to be and I've I've mentioned before that I've got people who've done master's degrees but I've also got complete novice novices completely new to implants uh what they all have uh in in in what they all have in common is a very similar mindset to myself that actually you know what if you learn biomechanics you do a better job the rest becomes easy and the business comes by

Wealth Levers, IV Sedation, And Where To Find Pav

Dr Pav 42:55

itself so these are people who want to learn real biomechanics so