Objective To study the possibility of using cone-beam computed tomography(CBCT)with CTAn software to analyze bone resistance during mandibular third molar extraction surgery.Methods Fifty-three patients who underwent CBCT scans for third molars at the Department of Stomatology from January 1st 2021 to July 31th 2023 were induded,involving a total of 91 mandibular third mo-lars.CTAn software was used to analyze the buccal and lingual bone volume regions around mandibular third molars in CBCT images,assessing three-dimensional bone microstructural parameters.Results Significant differences(P＜0.05)in tissue volume,trabecular bone volume/tissue volume,bone surface/trabecular bone volume,bone surface/tissue volume,and bone mineral density between the buccal and lingual bone volume areas were observed in both the total sample and in stratified analyses based on themesially inclined/verticalmandibular third molar impactionand gender.In high/mid-level mesially inclined and vertical impactions,females showed more significant differences in microstructural parameters of the buccal and lingual bone volume compared to males.Conclusion The inte-gration of CBCT with CTAn software offers a viable method for assessing bone resistance during mandibular third molar extractions.Lin-gual bone exhibits greater bone tissue content,denser trabeculae with smaller tissue volume compared to buccal bone.During mandibu-lar third molar extraction,compressing the buccal alveolar bone helps create trabecular compression space more easily.Additionally,the buccal alveolar bone is more amenable to grinding than the lingual side,thereby achieving a reasonable buccal dislocation of root.For female patients with high/mid-level mesially inclined and vertical impactions of the mandibular third molars,a buccal approach is more advisable to be followed.The evaluation of bone microstructural parameters and accurate determination of bone resistance offer valuable insights for the minimally invasive removal of impacted teeth.