Introduction: Panoramic radiograph is an image used by the dentist to maintain diagnosis in dentistry, for example, to evaluate teeth condition in mixed dentition period. There are two panoramic radiography techniques, which are conventional and digital (direct and indirect) method. This study was aimed to analyse the differences of panoramic radiograph image quality between the conventional and digital indirect method on mixed dentition radiograph. Methods: Thirty samples of conventional and indirect digital panoramic radiograph were randomly taken from the database according to inclusion criteria. The image quality of conventional radiograph was manually assessed by using illuminator box, while indirect digital radiographs was assessed directly using DBS Win 5.7.0 software (Durr Dental, Germany). The radiographs were divided into six zones: teeth area, nasal and sinus, mandible, TMJ, ramus-spine, and hyoid bone. The image quality assessment was performed in each area based on three criteria: anatomical coverage, density and contrast, and anatomical structure. Results: The Cronbach's Alpha Intra-Class Correlation (ICC) inter and intraobserver agreement test of conventional and digital indirect methods on the aspect of anatomical, density and contrast coverage, and anatomic structure showed an excellent agreement. The independent sample t-test result showed significant difference (p < 0.05) between the conventional and indirect digital method in density and contrast as well as anatomical structure aspects, but not significantly different (p > 0.05) in the anatomical coverage aspect. Conclusion: Indirect digital panoramic radiograph shows better image quality as compared to conventional radiograph, especially in the anatomical structure aspect, density and contrast. There is no difference in the anatomical coverage aspect between conventional and indirect digital panoramic radiograph.