The aim of this study was to compare the subjective diagnostic quality of F-speed film images and original and enhanced storage phosphor plate (SPP) digital images for the visualization of periodontal ligament space (PLS) and periapical (PB) and alveolar crestal bone (CB) and to assess the accuracy of these image modalities for the measurement of alveolar bone levels. Standardized images of six dried mandibles were obtained with film and Digora SPPs. Six evaluators rated the visibility of anatomical structures using a three-point scale. Alveolar bone levels were measured from the coronal-most tip of the marginal bone to a reference point. Results were compared by using Friedman and Wilcoxon signed-ranks tests. The kappa (kappa) statistic was used to measure agreement among observers. The measurements were compared using repeated measures analysis of variance and Bonferroni tests (P = 0.05). A paired t test was used for comparison with true bone levels (P = 0.05). Enhanced SPP images were rated superior, followed by film and then the original SPP images, for the evaluation of anatomical structures. The value of kappa rose from fair to substantial after the enhancement of the SPP images. Film and enhanced SPP images provided alveolar bone lengths close to the true bone lengths. Enhancement of digital images provided better visibility and resulted in comparable accuracy to film images for the evaluation of periodontal structures.