and then decorticated the bony three-wall defect also with Er,Cr:YSGG laser with same setting as mentioned above. The area was grafted with PepGen Flow (Dentsply, Mannheim, Germany) and membrane placed. The area was sutured and allowed to heal. Healing proceeded well and Figure 3 showed bone formation and minimal pocket depth that have been maintained after three years post-operation (Figure 4). Residual bacteria Second scenario to be discussed is a residual bacterium left within the bone by either apical pathology due to endodontic or periodontal involvements. Although the exact reasons are subject to speculation, many studies have suggested bacteria from previous infection initiate retrograde periimplantitis that are left at the surgical site [2]. A case that presented this was an immediate placement of implants into extraction of teeth with failed root canals. The site was curetted and detoxified with the use of Er,Cr:YSGG laser but failed to detoxify the non-implant site. 4 months after prosthetics was completed, the patient returned with a facial fistula as shown in Figure 5. The radiograph revealed pathology around the implant in position #26. On surgical appointment to clean around the implant (Figure 6), there was extensive bone loss, but implant was non-mobile and was in a four defect. The decision was to save the implant.