Aim: The aim of this study was to evaluate radiolucent lesions associated with impacted lower third molars, focusing on their pathological diagnosis and the distribution of sex and age among the affected individuals. Materials and methods: This retrospective cross-sectional study was conducted at King Khalid Dental University Hospital, Riyadh, Saudi Arabia, between January 2020 and August 2023. A total of 312 orthopantomography (OPGs) records were examined, covering 549 teeth. Data regarding impaction depth, ramus relationship, angulation classification, and the presence of lesions were analyzed. Results: Out of 549 teeth studied, 103 exhibited radiolucent lesions. These lesions were more frequently observed in male patients compared to female patients, and in individuals aged ≤30 years compared to those aged >30 years, showing significant differences. Most impacted teeth were classified as impaction depth A, indicating a position at the same or higher level relative to the occlusal plane of the second molar. Conclusion: The study found significant associations between the pattern of lower third molar impaction and dental characteristics (impaction depth classification, ramus relationship, angulation classification, and tooth type) with age. There was no significant association between gender and dental characteristics, except for the presence of a lesion. Clinical significance: Understanding the patterns of impaction and associated radiolucent lesions can help guide clinical decision-making regarding the management of impacted third molars, particularly in younger patients who may exhibit a higher risk of associated pathologies.