Dr. Jan Derks, PhD, does not arrive at opinions quickly. The Swedish periodontist and researcher has spent his career building the evidence base for how peri-implantitis develops, how it should be monitored, and what it entails to manage it at scale. His answers reflect that approach -- they are careful, precise, and grounded in data.
I spoke with Dr. Derks on June 27, 2026, at the Dentsply Sirona Implant Solutions World Summit in Gothenburg, Sweden. What followed was a conversation about the enduring value of the probe, the underreported problem of implant fracture, the dental hygienist's underappreciated role, and what the field needs to deliver before 2030.
DrBicuspid.com Editor-in-Chief Kevin Henry (left) listens to Dr. Jan Derks (right) in Gothenburg, Sweden, following the Dentsply Sirona Implant Solutions World Summit in Gothenburg, Sweden.Dentsply Sirona.
Kevin Henry: One of the things I felt you were most passionate about in your lecture today was probing and how important it is. Can you explain to our audience why you feel so strongly about it?
Dr. Jan Derks: We are looking for a tool that can quickly tell us whether an implant is doing well or whether there is reason for concern. Over time, we have evaluated many candidates against the same set of criteria: accurate, inexpensive, noninvasive, and quick. Those are the benchmarks for any diagnostic test.
And when you go through that list and look at the full history of what we have tried, you keep coming back to the probe. As it turns out, nothing outperforms it across all of those criteria -- even today. It may appear to be a crude method, and there are legitimate points of discussion, but it remains the best we have.
Do you find that most of your colleagues disagree with that position?
There has been a shift. Historically, this was a contested area. There was significant debate and disagreement, but I think the field has largely come around. Today, there is very little argument on this particular point.
There are genuine weaknesses in the method, and those are worth discussing. But conceptually, most colleagues now agree that probing is probably the right way to go.
In your lecture, you said that plaque is one of the major causes of peri-implantitis but also that other factors are involved.
Exactly. In this context, it is important to distinguish between the cause of a problem and the factors that modify it -- what we call risk factors. Those two things are easy to conflate, but the distinction matters.
The way we look at it: Plaque is the cause. Smoking, soft-tissue quality, and similar factors serve as risk factors -- they amplify the connection between plaque and disease, but they do not cause the disease on their own. If you remove plaque from the equation, there will not be any trouble, regardless of how much a patient smokes. That is our line of reasoning.
All of those factors are clinically important, and we address them, but in the back of our minds, plaque remains the singular etiological driver.
I also want to highlight one distinction I drew in my presentation: the mechanical problem. If you saw the fracture image I showed, there is a clear and separate etiological track that begins with a mechanical issue and sets off its own cascade. So plaque is the primary enemy, but it is not the only pathway.
You mentioned -- and correct me if I’m wrong -- that you believe fractured implants occur more often than is reported?
I believe so, though I want to be careful on this point. The published data suggest a very low incidence -- it should virtually not happen. But from our own clinical experience, we see a meaningful number of these cases every year, and those are only the obvious, clearly identifiable fractures.
What concerns me is the possibility that there is a much larger group of smaller, subclinical fractures that go unrecognized. In German, we use the term “dunkelziffer” -- the dark number, the figure behind the official one. I suspect the true number of fractures is considerably larger than what gets reported.
Hygienists, Dr. Jan Derks (right) told Kevin Henry (left), play a critical role in preventing peri-implantitis.Dentsply Sirona.
What do you see as the dental team’s role in addressing peri-implantitis?
It is fundamentally a team effort, particularly when it comes to prevention. The dentist’s role is obvious, and the dental technician’s role received a lot of emphasis from speakers throughout these two days, which was well deserved.
But the group that I think has not received enough attention -- and I will include myself in that oversight -- is the dental hygienist. Their role begins even before anyone is thinking about implants. It starts with preparing the patient, establishing good oral health and habits before treatment ever begins.
And then, of course, there is the maintenance phase afterward. Hygienists play a vital role in long-term prevention, both for periodontitis and for peri-implantitis. In Scandinavia, this has a long tradition, and we are now applying that same philosophy to implant care. Our hygienists are clinically skilled and up to date on diagnosis; they are fully equipped to manage these patients.
One of your colleagues mentioned aggressive implant placement. Is that something you are seeing more of today than in the past?
That term can be interpreted in a couple of different ways, so let me address both.
If we are talking about treatment strategy -- extracting teeth and moving quickly to implants -- I would actually say the field has been shifting in the opposite direction. Cases of failure have prompted a more conservative approach. The question being asked more often now is, "Can we maintain the tooth and postpone the implant?" The pendulum, at least in Europe, is swinging toward caution. I cannot speak for other regions.
If the term refers to implant design -- aggressive threading, for example -- then I think we have seen more pronounced thread designs come to market than we had previously. And from a peri-implantitis standpoint, that is a concern.
When we are managing a patient surgically or nonsurgically and decontamination is the goal, more expressive threading creates real challenges. Cleaning the flanks and the areas beneath the threads is simply harder. From that perspective, I would favor moderate or shallow thread profiles.
If there are colleagues who were not here today, what is the key message you would want them to take away?
Dr. Jan Derks (right) told Kevin Henry (left) that dentists offering -- or considering offering -- implant therapy should have a plan in place for combating peri-implantitis.Dentsply Sirona.
I would offer two.
The first is for any younger colleague setting up a clinic and considering implant therapy as part of their offering: Have a plan in place from Day 1. Peri-implantitis will occur. That is not pessimism. It is a clinical reality. Any center that places implants will eventually have to deal with it. So the question is not whether it will happen but whether you are ready when it does.
That means having a prevention protocol, knowing how you will follow your patients, and having someone with the expertise to manage treatment when it is needed -- whether that treatment is in-house or through referral. There has to be a plan.
The second message is about the probe. While you are preventing disease and monitoring your patients, probing should be your primary screening tool. The goal is to catch the problem early. Is it mucositis? Is it early peri-implantitis? Regardless, you want to identify it and address it before it progresses. The probe gives you that. It is accurate, it is available, and it works.
We are not far from the end of the decade. What do you hope has changed about implants and peri-implantitis by 2030?
Two things.
First, on the prevention side, I would like to see the industry recognize the opportunity and provide clinicians with products that genuinely reduce the risk of peri-implantitis. That could take many forms -- surfaces that are less conducive to biofilm formation, coatings, abutment modifications, and so on. Products designed with prevention in mind, not just performance.
Second, on the treatment side, for patients who are already affected, we need more effective methods of decontamination and long-term maintenance. We have tools today, and they work, but a meaningful proportion of patients still experience recurrence. We need something better, whether that is improved instrumentation, new decontamination technologies, or other approaches that simply outperform what exists now.
Of those two, prevention is the higher priority, because it reaches everyone. But for the 10% 20% of patients who develop peri-implantitis despite our best efforts, we need a more reliable treatment path. Those are my wishes for the end of this decade.
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