The present study aimed to determine which imaging modality—panoramic radiography (PAN) or cone-beam computed tomography (CBCT)—yields superior accuracy for vertical measurements in the maxillary posterior region. Anatomically matched locations across the maxillary posterior area were identified on both PAN and CBCT records and subjected to vertical assessment. The quantity measured was the linear distance extending from the osseous crest to the inferior boundary of the maxillary sinus cavity. Toothless segments underwent measurement following an identical protocol. Where a defect could be discerned, its vertical magnitude was separately quantified. The resulting dataset underwent statistical analysis. Pairwise comparison of matched sites on CBCT and PAN images yielded a cohort of 204 individuals, of whom 341 discrete measurements (n = 341) satisfied the enrolment criteria. Pooled mean values registered at 7.21 ± 3.74 mm using PAN and 7.62 ± 4.06 mm using CBCT. The average departure between paired readings was −0.41 ± 1.03 mm. The observed discrepancy between PAN- and CBCT-derived values was statistically significant (P < 0.001). Detectable defects were present at 58 of the 341 measurement sites (17%). Mean vertical extent of these defects measured 1.85 ± 1.05 mm on PAN versus 1.99 ± 1.00 mm on CBCT. Defect height comparisons did not attain statistical significance (P = 0.052). Despite a statistically demonstrable offset of −0.41 ± 1.03 mm emerging across all paired observations when juxtaposing PAN against CBCT vertical height readings, the magnitude of this offset proves clinically trivial upon consideration. Either PAN or CBCT constitutes a valid approach for ascertaining vertical bone dimensions in the posterior maxilla.
