© 2022, The Author(s) under exclusive licence to Japanese Society for Oral and Maxillofacial Radiology.Objectives: The purpose of this study is to evaluate the mandibular bone structure of patients with chronic renal failure (CRF) and compare to control group via the fractal analysis (FA) and radiomorphometric indices in the cone beam computed tomography (CBCT) images. Methods: Three observers retrospectively investigated 44 CBCT images to compare patients with CRF to healthy controls. FA was performed in two different areas, volume of interests (VOI) were chosen in the mandibular ramus and corpus. The CT cortical index (CTCI), CT mental index (CTMI), and CT mandibular index (CTI) were performed to determine cortical porosity and thickness. The normality distribution of numerical data was tested using the Kolmogorov–Smirnova and Shapiro–Wilk tests. According to the results, the Mann–Whitney U test and independent group t test were used for parameters. The chi-square test was used to evaluate the distribution of categorical variables by groups. Results: There were statistically significant differences in VOI1 and VOI2. The fractal dimension (FD) values in VOI1 and VOI2 were significantly lower in study group. There were no significant differences in CTCI, CTMI and CTI measurements between both groups. Conclusions: CRF is a prevalent cause of radiographic abnormalities in jawbones. The FD values in trabecular bone decreased in study group, although there were no significant differences in the radiomorphometric indices. FA in CBCT images could be useful for a three-dimensional evaluation of trabecular bone structure.