Objectives: This research aims to investigate how Diabetes Mellitus relates to the shapes seen in mandibular X-rays. Fractal analysis can be used to examine variations in bone structure and to determine whether panoramic radiography is a beneficial screening technique for osteoporosis in people with diabetes. Review: This investigation is a thorough review of existing literature conducted from August to September 2024, adhering to PRISMA guidelines. Research articles were gathered from PubMed, Scopus, Elsevier, and DOAJ databases, focusing on terms related to diabetes, radiomorphometry, and fractal analysis. The articles included were published between 2015 and 2024, in English, open-access, and relevant to using panoramic radiography or CBCT for identifying changes in bone due to DM. Initially, 860 articles were found, but after screening, only three cross-sectional studies met all the criteria. The analysis of these studies indicated that individuals with diabetes had lower scores on radiomorphometric measures such as the Mental Index (MI), Antegonial Index (AI), and Gonial Index (GI) should be consulted as a group when compared to measurements from healthy individuals. The Mandibular Cortical Index (MCI) was observed to have a negative correlation with bone mineral density in individuals diagnosed with type 2 diabetes. Furthermore, fractal evaluation revealed a decline in the trabecular bone architecture of individuals with diabetes type 1 diabetes, showing that DM negatively impacts the shape and structural quality of bones. Radiographic panoramas indicate that they might be an effective screening method for assessing osteoporosis risk in diabetics, and they can also demonstrate changes in the structure of the mandible. Conclusion: These outcomes point to the necessity for more research utilizing larger groups of participants and prospective study frameworks to more clearly define the connection between DM and changes in bone structure with Panoramic.