Our study aimed to assess mandibular osseous changes using radiomorphometric indices by Cone-Beam Computed Tomography (CBCT) in patients with end-stage renal failure (ESRF) to evaluate their jaw bone quality versus a healthy sex- and age-matching population. Twenty-six patients were included in this study. They were divided equally into two groups. The first group (study group) included 13 ESRF patients and the second group (control group) included 13 patients free from any condition that could affect bone metabolism. All of the 26 participants were scanned using CBCT scanner then five indices were obtained from the reformatted panoramic images and the cross-sectional images of each mandible bilaterally mandibular cortical index (MCI), panoramic mandibular index (PMI), mental index (MI), gonial index (GI), and antegonial index (AI). There was no significant difference between MCI, MI, AI, GI and PMI of patients with ESRF and that of the control group. The assessment of intra-observer and inter-observer reliability regarding all measurements (GI, AGI, MI, and PMI) showed very strong agreement except MCI showed substantial agreement. Bone quality assessment of patients, investigated in the current study, with ESRF was not different from those of healthy sex- and age-matching dental patients using radiomorphometric indices. Quantitative radiomorphometric indices (MI, AI, GI, and PMI) are more reliable than qualitative radiomorphometric index (MCI) in the assessment of jawbones.