Purpose : The purpose of this experiment was to evaluate the diagnostic ability of a CCD-based digital system (CDX-2000HQ) in the detection of incipient dental caries. Materials and Methods : 93 extracted human teeth with sound proximal surfaces and interproximal artificial cavities were radiographed using 4 imaging methods. Automatically processed No.2 Insight film (Eastman Kodak Co., U.S.A.) was used for conventional radiography, scanned images of conventional radiograms for indirect digital radiography were used. For the direct digital radiography, the CDX-2000HQ CCD system (Biomedisys Co. Korea) was used. The subtraction images were made from two direct digital images by Sunny program in the CDX-2000HQ system. Two radiologists and three endodontists examined the presence of lesions using a five-point confidence scale and compared the diagnostic ability by ROC (Receiver Operating Characteristic) analysis and one way ANOV A test. Results: The mean ROC areas of conventional radiography, indirect digital radiography, direct digital radiography, and digital subtraction radiography were 0.9093, 0.9102, 0.9184, and 0.9056, respectively. The diagnostic ability of direct digital radiography was better than the other imaging modalities, but there were no statistical differences among these imaging modalities (p > 0.05). Coclusion : These results indicate that new CCD-based digital systems (CDX-2000HQ) have the potential to serve as an alternative to conventional radiography in the detection of incipient dental caries.