Adequacy of Radiographic Reportage in Endodontic Treatment: A Retrospective Review from a Teaching Hospital in Southwest Nigeria

Abstract

Background: Understanding the patterns of documentation among endodontic caregivers, ranging from students and registrars to consultants, can provide valuable insights into systemic strengths and weaknesses within dental service delivery frameworks.

Objective: This study evaluated the adequacy of radiographic documentation in endodontic treatment, assessing the frequency of preoperative, intraoperative, and postoperative radiographs, and determining factors associated with adequate reportage.

Methods: A retrospective review was conducted on 357 patient records treated for endodontic conditions at a tertiary dental hospital. Data extracted included demographic variables, designation of the attending caregiver, radiographic documentation, diagnosis, and treatment type. Adequacy of radiographic reportage was defined by inclusion of the coronal surface, apical structures, periodontal ligament space, and canal patency in the recorded findings. Descriptive and inferential statistics, including chi-square tests, were performed at a 5% significance level.

Results: Patients were predominantly aged 20–29 years (25.2%) and female (56.0%). Most treatments were rendered by registrars (88.2%). Although 96.9% of cases had preoperative radiographs, and 88.5% and 85.7% had master cone and obturation radiographs respectively, only 16.2% of records met the criteria for adequate documentation. Acute apical periodontitis (36.4%) was the most common diagnosis, and conventional root canal therapy accounted for 86.8% of treatments. The association between caregiver designation and adequacy of radiographic documentation was not statistically significant (p = 0.287).

Conclusion: While radiographs were widely utilized in endodontic care, comprehensive documentation was suboptimal. Structured training and adherence to documentation protocols are essential to improve radiographic reporting standards and ensure medico-legal accountability in clinical practice.

Keywords:

Endodontic treatment, radiographic documentation, root canal therapy, dental records, audit, quality of care

References

Ng JM, Lee YY, Chippagiri P, Ahanin E, Parolia A. Effect of quality of radiographs taken during root canal treatment on technical quality of root canal fillings and endodontic outcome. Restorative dentistry & endodontics. 2025 Jan 7;50(1): rde-2025.

Mahasneh SA, Horner K, Cunliffe J, Al‐Salehi S, Sengupta A, AlHadidi A. Guidelines on radiographic imaging as part of root canal treatment: a systematic review with a focus on review imaging after treatment. International Endodontic Journal. 2018 Apr;51: e238-49.

King E, Shekaran L, Muthukrishnan A. Improving the quality of endodontic record keeping through clinical audit. British Dental Journal. 2017 Mar 10;222(5):373-80.

Tokede O, Ramoni RB, Patton M, Da Silva JD, Kalenderian E. Clinical documentation of dental care in an era of electronic health record use. Journal of evidence based dental practice. 2016 Sep 1;16(3):154-60.

European Society of Endodontology. Quality guidelines for endodontic treatment: consensus report of the European Society of Endodontology. International endodontic journal. 2006 Dec;39(12):921-30.

Simons D, Williams D. Can audit improve patient care and treatment outcomes in endodontics? British Dental Journal. 2013 May 11;214(9): E25-.

Chong BS, Miller J, Sidhu S. The quality of radiographs accompanying endodontic referrals to a health authority clinic. British Dental Journal. 2015 Jul 24;219(2):69-72.

Eckerbom M, Magnusson T. Evaluation of technical quality of endodontic treatment–reliability of intraoral radiographs. Dental Traumatology. 1997 Dec;13(6):259-64.

Lin GS, Tan WW, Chan DZ, Chua KH, Yee TC, Lazaldin MA. Quality of endodontic record-keeping and root canal obturation performed by final year undergraduate dental students: An audit during the COVID-19 pandemic. Plos one. 2022 Oct 3;17(10):e0275634.

Yeoh WC, Koay CG, Kong GY, Gan EW, Libat R, Babar MG, Parolia A. Evaluation of Quality of Record-Keeping and Root Canal Therapy Performed by Two Predoctoral Cohorts. Dentistry journal. 2025 Apr 19;13(4):174.

Olakotan O, Samuriwo R, Ismaila H, Atiku S. Usability Challenges in Electronic Health Records: Impact on Documentation Burden and Clinical Workflow: A Scoping Review. Journal of Evaluation in Clinical Practice. 2025 Jun;31(4):e70189.

Jacob C, Sanchez-Vazquez A, Ivory C. Factors impacting clinicians’ adoption of a clinical photo documentation app and its implications for clinical workflows and quality of care: qualitative case study. JMIR mHealth and uHealth. 2020 Sep 23;8(9):e20203.

World Medical Association. World Medical Association Declaration of Helsinki: ethical principles for medical research involving human subjects. Jama. 2013 Nov 27;310(20):2191-4.

Rowlands S, Tariq A, Coverdale S, Walker S, Wood M. A qualitative investigation into clinical documentation: why do clinicians document the way they do?. Health Information Management Journal. 2022 Sep;51(3):126-34.

Clynch N, Kellett J. Medical documentation: part of the solution, or part of the problem? A narrative review of the literature on the time spent on and value of medical documentation. International journal of medical informatics. 2015 Apr 1;84(4):221-8.

Morgan RG. Quality evaluation of clinical records of a group of general dental practitioners entering a quality assurance programm. British dental journal. 2001 Oct;191(8):436-41.

Javed MQ, Kolarkodi SH, Riaz A, Nawabi S. Quality assurance audit of digital intraoral periapical radiographs at the undergraduate dental clinics. J Coll Physicians Surg Pak. 2020 Dec 1;30(12):1339-42.

Khan A, Javed MQ, Iqbal R, Khan F, Habib SR. Quality assurance audit of intra-oral periapical radiographs at the undergraduate dental school. Journal of Ayub Medical College Abbottabad. 2020 Jun 16;32(3):327-30.