Temporising endo access cavities and removing cotton pellets

I have recently been getting back into endos after spending the past year referring them to the principal dentist who was an endo aficionado. I find endos quite difficult, therefore time consuming and draining. Logically I know that the less I like something, the more I should do of it to become proficient but I thought that I had reached a point in my career where I could focus on my special interests. However, due to changes in my work circumstances, I have to take on these procedures again. 

I have recently gone through the All things endo online course from Ashley Mark in the US (https://all-things-dentistry.teachable.com/courses). It was a very cost effective course that gave a good refresher for endo knowledge. The main benefit I got from it was the repetition of recordings of endo accesses. This is the most important part of the endo procedure and improves the outcome of each step follow this. Seeing this being done over and over with some tips to give confidence to know that I am in the right area allowed me to do the next couple of molar endo accesses with more confidence. Still, I am struggling with the procedure but I am hoping this will come with time.

One issue I have had in the past was trying to dig out the cotton pellet spacer from endo accesses and implant screw access channels. I have switched to PTFE tape to close these accesses but I am mainly encountering cotton pellets when reaccessing implants to change crowns over or retighten prosthetic screws. Implant screw accesses tend to be quite a lot narrower and deeper than molar endo accesses but anterior teeth and premolar endo accesses can be quite challenging to fish material out of. Single canal anterior teeth also lack a pulp floor and I am very against putting a cotton pellet into them as I have had to fish these out from near the apex. The other big issue with cotton pellets in accesses is any stray strands of cotton that aren't pushed fully through the access will act as a highway for bacteria through the temporary filling material.

PTFE tape is probably a good alternative as it becomes very firm when compacted so if the pellet is of an appropriate size it has less risk of being forced too far apically. However, as it becomes a firm barrier it becomes more difficult to remove from narrow accesses. I prefer just putting cavit directly over the medicament. I got a ball of cavit and use my fingers to roll it into a cone shape with the point end being threaded into the canal and pushed down with an instrument or finger to adapt it to the cavity margins. It works quite well as a temporary without any restoration on top for up to a few weeks. I haven't had any issues in the past with cavit going too far down the canal. If a fine ultrasonic tip is used with water irrigation, the cavit will breakdown and dissolve.

I was given a tip lately for removing cotton pellets from accesses. Use a large sized endodontic H file and rotate it to wind the cotton pellet around it. A size 40 and above will be effective, the larger the better. This is a much faster method than trying to use an explorer to try to grab the pellet.

I will need to put much more effort in practicing my endo skills, I have saved a few extracted teeth which I will hopefully be able to find some time to practice my endo on in the coming weeks.