## 4 Discussion  
This study established an in vitro model mimicking clinical peri-implant intra-bony defects. We investigated the effects of access limitation and the bactericidal effectiveness of Er:YAG laser irradiation in shallow and deep peri-implant defects at different tooth positions. Most previous in vitro studies investigating the effects of bacterial adhesion and the cleaning effects of different instruments have used titanium discs instead of root-form dental implants [19; 20; 21; 22; 27; 28]. Other studies utilized root-form dental implants embedded in resin blocks [23]. The effects of implant surface topography and surrounding bony defects on the efficacy of cleaning contaminated implant surfaces cannot be accurately evaluated using these models. Utilizing designable, re-printable 3D models with replaceable suites, the present study showed effective sterilization using Er:YAG laser irradiation with both shallow and deep peri-implant intra-bony defects at different positions and diameters of dental implants. The effectiveness of laser irradiation on contaminated implant surfaces in a peri-implant defect may be influenced not only by the bony defect configuration, but also by peri-implant tissues in clinical or in vivo studies. Authors of a systematic review regarding periodontal and peri-implant \begin{table}
\begin{tabular}{c c c c} \hline \hline \multicolumn{4}{c}{**Bacterial Adhesion on Dental Implants**} \\ \hline
**Position** & **Sample** & **Adhesion Rate (\%)** & **Mean \(\pm\) SD** \\ \hline \multirow{4}{*}{Incisor (3 mm)} & Sample 1 & 1.25 & \multirow{4}{*}{\(1.76\pm 1.25\)} \\  & Sample 2 & 3.85 & \\  & Sample 3 & 1.01 & \(1.76\pm 1.25\) \\ \cline{1-1}  & Sample 4 & 0.74 & \\  & Sample 5 & 1.97 & \\ \hline \multirow{4}{*}{Premolar (4 mm)} & Sample 1 & 1.94 & \multirow{4}{*}{\(2.19\pm 0.75\)} \\  & Sample 2 & 1.56 & \\ \cline{1-1}  & Sample 3 & 3.3 & \multirow{4}{*}{\(2.19\pm 0.75\)} \\  & Sample 4 & 1.54 & \\ \cline{1-1}  & Sample 5 & 2.58 & \\ \hline \multirow{4}{*}{Molar (5 mm)} & Sample 1 & 1.78 & \multirow{4}{*}{\(2.66\pm 1.26\)} \\  & Sample 2 & 1.20 & \\ \cline{1-1}  & Sample 3 & 2.62 & \multirow{4}{*}{\(2.66\pm 1.26\)} \\ \cline{1-1}  & Sample 4 & 4.37 & \\ \cline{1-1}  & Sample 5 & 3.34 & \\ \hline \hline \end{tabular}
\end{table} 
Table 2: Bacterial adhesion on different sandblasted and acid-etched dental implants with deep (6 mm) intra-bony defects at different tooth positions. \begin{table}
\begin{tabular}{c c c c c c} \hline \hline \multirow{4}{*}{**Alevelor**} & \multirow{4}{*}{**Position**} & \multicolumn{4}{c}{**Er:YAG Laser Sterilization Results**} \\  & & **Incisor (mm)** & **Premolar (4 mm)** & **Molar (5 mm)** \\  & & **Sterilization** & **Mean \(\pm\) SD** & **Sterilization** & **Mean \(\pm\) SD** \\ \hline \multirow{4}{*}{6 mm} & Sample1 & 99.9 & \multirow{4}{*}{99.3} & \multirow{4}{*}{99.7} \\  & Sample2 & 99.9 & & 99.7 & \\ \cline{1-1}  & Sample3 & 100 & 99.6 \(\pm\) 0.5 & 98.6 & 99.3 \(\pm\) 0.41 & 97.3 \\ \cline{1-1}  & Sample4 & 98.9 & & 99.4 & \\ \cline{1-1}  & Sample5 & 99.2 & & 99.7 & 98 & \\ \cline{1-1}  & Sample1 & 99.1 & & 99.6 & 99 & \\ \cline{1-1}  & Sample2 & 99.7 & & 99.9 & \\ \cline{1-1}  & Sample3 & 99.8 & 99 \(\pm\) 1.35 & 99.3 & 99.1 \(\pm\) 0.98 & 95.1 & 97.14 \(\pm\) 2.57 \\ \cline{1-1}  & Sample4 & 99.6 & & 99.2 & 98.5 & \\ \cline{1-1}  & Sample5 & 96.6 & & 97.4 & 93.7 & \\ \hline \hline \end{tabular}
\end{table} 
Table 3: Erbium-doped yttrium, aluminum and garnet (Er:YAG) laser sterilization results with different levels of alveolar resorption and positions. wound healing following laser therapy stated that non-surgical therapy may not be sufficient for the healing of peri-implantitis sites [29]. The authors also found that the erbium lasers are advantageous in peri-implant surgery because of their favorable bone healing potential. [PERSON] et al. reported that surgical therapy is a predictable method for treating peri-implantitis but laser treatment of the exposed implant surface during surgery was not shown to be beneficial [30].