Cone beam CT and/or panoramic images are often required for a successful diagnosis in oral and maxillofacial surgery. The aim of this study was to evaluate if 3D diagnostic imaging information had a significant impact on the decision process in six different classes of surgical indications. Material and methods: Records of all patients who had undergone both panoramic X-ray and CBCT imaging due to surgical indications between January 2008 and December 2012 were examined retrospectively. In February 2013, all surgically relevant diagnoses of both conventional panoramic radiographs and CBCT scans were retrieved from the patient's charts. It was recorded whether (1) 3D imaging presented additional surgically relevant information and (2) if the final decision of surgical therapy had been based on 2D or 3D imaging. Results: A total of 253 consecutive patients with both panoramic radiographs and CBCT analysis were eligible for the study. 3D imaging provided significantly more surgically relevant information in cases of implant dentistry, maxillary sinus diagnosis and in oral and maxillofacial traumatology. However, surgical strategies had not been influenced to any significant extent by 3D imaging. Conclusion: Within the limitations of this study it may be concluded that CBCT imaging results in significantly more surgically relevant information in implant dentistry, maxillary sinus diagnosis and in cases of oral and maxillofacial trauma. However, 3D imaging information did not alter significantly the surgical plan that was based on 2D panoramic radiography. Further studies are necessary to define indications for CBCT in detail.