AIMS: The aim of this study was to investigate the effect of two different bisphosphonate types on bone using dental panoramic radiographs (DPRs) and to compare these findings with a healthy cohort. STUDY DESIGN: Panoramic dental radiographs of bisphosphonate users (30) and healthy individuals (30) were retrospectively evaluated for the study. Regarding FA, standardized 50 × 50 pixel regions of interest (ROI) were identified for each patient. Moreover, the assessment encompassed Mandibular Cortical Width (MCW), Panoramic Mandibular Index (PMI), and Mandibular Cortical Index (MCI). A significance level of p <
0.05 was deemed to be statistically significant. RESULTS: The case group showed significantly higher MCW and PMI measurements than the control group (p <
0.001). Right and left MCI measurements differed depending on the type of drug used (p = 0.008 and p = 0.019, respectively). No discernible correlation was found between the time elapsed since the last dose and any measurement values (p >
0.05). CONCLUSION: This study showed that bisphosphonate type and duration of drug use have a significant effect on changes in cortical bone structure. The persistence of these effects, unaffected by the time since the previous dose, suggests that bisphosphonates have a long-lasting effect on bone.