Objective: The present study was performed to determine the relationship betweenimpacted mandibular third molars and the inferior alveolar nerve by comparing thepanoramic signs with cone beam CT findings to predict the probability ofneurovascular bundle exposure following extraction.Methods: Thirteen patients with age range 25-35 years old having impactedmandibular third molars were included in the study. All patients were subjected topreoperative digital panoramic radiography and cone beam CT imaging.Panoramic images were evaluated for the presence of radiographic signs ofapproximation to the inferior alveolar nerve and cone beam CT images wereevaluated for the actual position of the inferior alveolar nerve. All impactions wereremoved surgically under local anaesthesia. The neurosensory disturbances of thelip and chin were assessed after one and two weeks postoperatively. Statisticalanalysis was performed to compare the panoramic, cone beam CT and clinicalfindings.Results: There was no statistically significant association between IAC position orcontact of IAC and tooth on CBCT images and panoramic findings. However,lingual cortical plate thinning and perforation showed a statistically significantassociation with buccally and inferiorly-positioned canals. Clinically, no casesshowed permanent nerve damage; however, three cases (23.1%) had numbness andno statistically significant association was found neither between clinical andpanoramic findings nor between clinical and CBCT findings.Conclusion: CBCT provided useful information regarding the 3D relationshipbetween the mandibular third molar and the IAC. Thus it can be used for riskassessment and surgical planning. The non significant correlation betweenpanoramic and CBCT imaging denoted the insufficient value of panoramicradiography in predicting the relationship of the impacted mandibular third molarto the IAC. The non significant correlation between CBCT and clinical findingsdenoted the influence of CBCT on the surgical manoeuvre when contact with theIAC was observed.