Introduction : Mandibular third molars are the most frequently impacted teeth and are associated with various pathoses ranging from infection, inflammatory to cystic lesions necessitating their removal. Neurosensory disturbances related to the inferior alveolar nerve due to the close anatomic relationship between the roots of mandibular third molars and the inferior alveolar canal is one of the most grave complications of such a procedure. This study aimed to assess the radiographic proximity (distance) and the reliable radiographic risk predictor signs that indicate close proximity of impacted mandibular third molars to the inferior alveolar canal on panoramic radiographs to guide the dental surgeon in pre–surgical treatment planning.

Methods: This study comprised of 60 subjects with symptomatic impacted mandibular third molars. They were clinically examined and panoramic radiographs were made. The radiographs were interpreted for type of impaction, proximity (distance) from impacted mandibular third molars to inferior alveolar canal and presence of radiographic risk predictor signs. Further, these teeth were surgically removed and the proximity was assessed based on the exposure of inferior alveolar canal/nerve which was considered as Gold standard.

Results: The overall mean distance from the impacted mandibular third molars to inferior alveolar canal was –0.792 mm most of the (59%) samples extended beyond the superior border of the inferior alveolar canal. Vertical impactions were found to be in the close proximity (–2.00 mm) to inferior alveolar canal. Interruption of the white line was the most frequently observed sign on panoramic radiographs. No statistical significant association was found between the radiographic signs on surgical evaluation.

Conclusion: There is no any positive correlation between presence of radiographic signs of third molar proximity with Inferior alveolar nerve on surgical evaluation..