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case report | Fig. 3a Fig. 3b Fig. 3c tient smoked more than one pack of cigarettes per day. Physical examination demonstrated a light brown, “furry” dorsal surface on the tongue (Fig. 1). The patient was diagnosed with black hairy tongue. After obtaining a written consent by the patient, a new approach was applied to treat the condition us- ing a combination of laser ablation with Er:YAG laser and methylene blue-mediated photodynamic ther- apy (PDT) with diode laser. Ablation therapy During the fi rst treatment session, the elongated papillae were ablated with Er:YAG laser (LiteTouch, Light Instruments, Israel) using “chisel” tip at the fol- lowing parameters: 200 mJ/18 Hz (3.6 W) with water cooling. Only topical anaesthesia with 10 per cent li- docaine spray was performed prior to the procedure (Figs. 2a &b). The removed papillae were microbio- logically tested and evaluated under SEM (Fig. 3). Toluidine blue-mediated photodynamic therapy The laser ablation of the elongated papillae of the tongue enhanced the consequent PDT (one day after) due to the better penetration of laser light and spread- ing of the photosensitiser over the affected area. Five sessions of PDT were performed with the toluidine blue photosensitiser at a concentration of 0.5 per cent applied on the dorsum of the tongue. After fi ve min- utes of pre-irradiation time for photosensitiser pene- tration, the excess was removed and laser activation was done with infrared (890 nm and wavelength of aiming beam 635 ± 10 nm) diode laser ( LITEMEDICS dental laser, LAMBDA SpA, Italy) using a bleaching handpiece at 0.5 W (cw) for 60 seconds (Fig. 4). Fig. 3: The removed “hairs” (a) observed under SEM (b) are highly elongated cornifi ed spines that result from delayed desquamation of the cells in the central column of fi liform papillae and marked retention of secondary papillary cells. The microbiological tests revealed Candida albicans infection (c). Results Follow-up examinations one month as well as three, six and twelve months later revealed signifi - cant improvement of the condition with no signs of relapse (Fig. 5). Discussion The pathophysiology of BHT has not been fully elucidated.1,7 Defective desquamation of the dorsal surface of the tongue is described in a SEM study.8 Our fi ndings confi rmed these conclusions. This mor- phology prevents normal debridement, leading to an ANZEIGE Publish your expertise! your expertise! Become an author for laser — international magazine of laser dentistry issn 2193-4665 laser international magazine of laser dentistry 2 2017 case report Diode-laser assisted case report Treatment of black hairy tongue industry Please contact: © Peshkova /Shutterstock.com OEMUS MEDIA AG · Holbeinstraße 29 · 04229 Leipzig · Germany · Phone: +49 341 48474-0 · info@oemus-media.de