<jats:title>Abstract</jats:title><jats:sec><jats:title>Background</jats:title><jats:p>The use of a cone beam computed tomography (<jats:styled-content style="fixed-case">CBCT</jats:styled-content>) for the preoperative implant planning is increasing. A clear guideline is needed in which cases of <jats:styled-content style="fixed-case">CBCT</jats:styled-content> is essential.</jats:p></jats:sec><jats:sec><jats:title>Purpose</jats:title><jats:p>In this study, two imaging modalities (panoramic radiograph and <jats:styled-content style="fixed-case">CBCT</jats:styled-content>) are compared in preoperative implant planning in the severely resorbed mandible and the influence on the observers assessments.</jats:p></jats:sec><jats:sec><jats:title>Materials and Methods</jats:title><jats:p>Thirty‐four consecutive patients with bilateral edentulous regions in the mandible were included. The feasibility of implant placement in the premolar and molar region was judged by three observers on basis of casts either with a panoramic radiograph or a <jats:styled-content style="fixed-case">CBCT</jats:styled-content>.Cohen's kappa, sensitivity and specificity rates, odds of agreement and disagreement as well as the odds ratios (<jats:styled-content style="fixed-case">OR</jats:styled-content>s, ratio between odds of agreement and disagreement) were calculated per observer and overall for all observers assuming the majorities agreement as the prevailing opinion.</jats:p></jats:sec><jats:sec><jats:title>Results</jats:title><jats:p>Overall outcome for premolar region revealed true‐positive and true‐negative rates of 90% and 0%, respectively, with <jats:styled-content style="fixed-case">C</jats:styled-content>ohen's kappa (κ) = −0.04. The <jats:styled-content style="fixed-case">OR</jats:styled-content>s for the three observers varied between 2.6 and 158.8, with an overall <jats:styled-content style="fixed-case">OR</jats:styled-content> = 76.For the molar region, overall true‐positive and true‐negative rates were 65% and 22% respectively, with <jats:styled-content style="fixed-case">C</jats:styled-content>ohen's κ = 0.68, representing a reasonable amount of agreement. Sensitivity and specificity as well as the <jats:styled-content style="fixed-case">OR</jats:styled-content>s for individual observers were fairly consistent with an overall <jats:styled-content style="fixed-case">OR</jats:styled-content> = 43.</jats:p></jats:sec><jats:sec><jats:title>Conclusion</jats:title><jats:p>Implant placement in the resorbed posterior mandible can be well assessed with a cast in combination with a panoramic radiograph in the vast majority of the cases. Misclassification amounts to approximately 10% to 13%. In all cases of misclassification, a critical bone height, or an unclear course of the mandibular nerve or a knife edge ridge was present. In these cases, the use of a <jats:styled-content style="fixed-case">CBCT</jats:styled-content> is justified.</jats:p></jats:sec>