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The tray is then worn full time for up to 4 days generic kemadrin 5 mg without a prescription medicine 93 7338, the gel being replaced every 2-4 h. Once an aesthetically acceptable result is achieved the access cavity is refilled appropriately. Long-term results are not yet available for this approach with relapse being as likely as any of the other bleaching techniques. The technique has achieved considerable success in the United States, but it is a lengthy and time-consuming procedure that requires a high degree of patient compliance and motivation. Indications (1) very mild tetracycline staining without obvious banding; (2) mild fluorosis; (3) yellowing due to ageing; (4) single teeth with sclerosed pulp chambers and canals. Armamentarium (1) rubber dam with clamps and floss ligatures; (2) Orabase gel; (3) topical anaesthetic; (4) gauze; (5) 37% phosphoric acid; (6) heating light with rheostat; (7) 30-volume hydrogen peroxide; (8) polishing stones; (9) fluoride drops (0-2 years: drops). Coat the buccal and palatal gingivae with Orabase gel as extra protection from the bleaching solution. The end teeth should be clamped (usually from second premolar to second premolar). Cover the metal rubber dam clamps with damp strips of gauze to prevent them from getting hot under the influence of the heat source. Etch the labial and a third of the palatal surfaces of the teeth with the phosphoric acid for 60 s, wash, and dry. Thoroughly soak a strip of gauze in the 35% hydrogen peroxide and cover the teeth to be bleached. Set the rheostat to a mid-temperature range and increase it until the patient can just feel the warmth in their teeth, and then reduce it slightly until no sensation is felt. Keep the gauze damp by reapplying the hydrogen peroxide every 3-5 min using a cotton bud. Make sure the bottle is closed between applications as the hydrogen peroxide deactivates on exposure to air. After 30 min remove the rubber dam, clean off the Orabase gel, and polish the teeth using the shofu stones.

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