Morphological Variation in the Mandibular Ramus in Different Skeletal Characteristics: A Dual Radiographic Analysis

Background: Lateral cephalometry is the reference standard for two-dimensional dentoskeletal analysis; however, superimposition limits bilateral mandibular assessment in asymmetric conditions. Panoramic radiography provides bilateral visualization with lower radiation exposure, but its reliability remains debated. This study evaluated the agreement between panoramic and cephalometric angular measurements and assessed mandibular variations according to skeletal class, vertical pattern, and sex. Methods: Standardized panoramic and lateral cephalometric radiographs of 304 adults (18–30 years) were analyzed. Corresponding angular measurements were compared using correlation and regression analyses, and subgroup differences were evaluated across skeletal classifications and sex. Results: Significant correlations were found between selected parameters, particularly Ar-Go-Me and OMAND (r = 0.52) and FH/U6-U1 and FH/UOP (r = 0.66). However, regression analyses showed moderate explanatory power. Mandibular dimensions were significantly greater in males, and Class III hyperdivergent individuals exhibited steeper angular patterns. Conclusions: Panoramic radiography can approximate certain cephalometric angles and may serve as an adjunctive diagnostic tool. However, due to limited predictive accuracy, it cannot replace cephalometric analysis for definitive orthodontic treatment planning. Mandibular morphology is strongly influenced by vertical skeletal pattern and sex.