Statistical analysis

This study investigates the diagnostic value and interobserver reliability of panoramic radiographic signs in predicting the relationship between mandibular third molar roots and the inferior alveolar canal, using cone-beam computed tomography (CBCT) as the reference standard. In addition, we propose and validate a selective CBCT indication protocol aimed at improving diagnostic decision-making while minimizing unnecessary radiation exposure.The main strengths of this study include:• A comprehensive comparison between panoramic radiography and CBCT using multiple diagnostic performance metrics. • Evaluation of interobserver reliability among clinicians with different levels of experience. • Validation of a selective CBCT referral algorithm designed to optimize radiation exposure while maintaining diagnostic accuracy. • Robust statistical analysis with direct clinical applicability in oral surgery and dentomaxillofacial radiology.We believe this work will be of particular interest to clinicians and researchers in oral and maxillofacial surgery, dentomaxillofacial radiology, and diagnostic imaging, as it provides evidence-based guidance for preoperative imaging assessment in mandibular third molar surgery.This manuscript is original, has not been published previously, and is not under consideration for publication elsewhere. All authors have reviewed and approved the final version of the manuscript.The authors declare no conflicts of interest. All relevant ethical approvals and patient consent procedures were obtained in accordance with institutional guidelines.