A preoperative radiographic assessment of impacted third molars remains critical, as determining the relationship between the roots and the IAC is key to predicting risk and preventing postoperative sensory damage. The aim of this retrospective study was to evaluate panoramic radiographic markers and CBCT findings to predict the proximity of impacted third molars to the IAC. Materials: We studied 260 impacted mandibular third molars from 214 patients who showed a close relationship between the IAC and lower third molars on panoramic radiographs. Patients who were referred to radiolo-gy clinics at Princess Nourah Bint Abdulrahman University for CBCT examination prior to extraction of lower third molars. The correlation between panoramic findings and CBCT was analyzed using a Chi-square test and Fisher's exact test. Results: The most common risk markers seen on panoramic images were diversion of the mandibu-lar canal, deflection of the roots, interruption of the mandibular canal, and narrowing of the roots. There was a statistically significant association between those panoramic markers and the communication of roots with the IAC on CBCT. Conclusion: CBCT is recommended for evaluating the anatomical relationship between impacted third mo-lars and the IAC when a panoramic radiograph shows a deflection of roots or a diver-sion or interruption of the mandibular canal.