Density and gray-scale changes in radiographs are important visual features the clinician uses to evaluate changes in bone pattern. With the advent of a new direct digital radiology system, RadioVisioGraphy (RVG), the controlled adjustment of contrast is now possible. The purpose of this study was to compare RVG's diagnostic potential for detecting periapical lesions with that of conventional radiography. Lesions were created in human cadaver specimens and radiographed conventionally and with RVG. Images were evaluated by three endodontists. Results were: (a) when no lesion existed, conventional radiographs were more diagnostic than RVG at a significance level at p < or = 0.05; (b) when lesions were enlarged to involve lamina dura and medullary bone, RVG was superior at p < or = 0.05; and (c) no difference was found between conventional radiography and RVG when the lesion involved cortical bone.