PURPOSE: To evaluate the diagnostic accuracy of occlusal and proximal caries detection using CCD, CMOS, PSP and film system. MATERIALS AND METHODS: 32 occlusal and 30 proximal tooth surfaces were radiographed under standardized conditions using 3 digital systems; CCD (CDX-2000HQ, Biomedysis Co., Seoul, Korea), CMOS (Schick, Schick Inc., Long Island, USA), PSP (Digora (R) FMX, Orion Co./Soredex, Helsinki, Finland) and 1 film system (Kodak Insight, Eastman Kodak, Rochester, USA). 5 observers examined the radiographs for occlusal and proximal caries using a 5-point confidence scale. The presence of caries was validated histologically and radiographically. Diagnostic accuracy was evaluated using ROC curve areas (Az). RESULTS: Analysis using ROC curves revealed the area under each curve which indicated a diagnostic accuracy. For occlusal caries, Kodak Insight film had an Az of 0.765, CCD one of 0.730, CMOS one of 0.742 and PSP one of 0.735. For proximal caries, Kodak Insight film had an Az of 0.833, CCD one of 0.832, CMOS one of 0.828 and PSP one of 0.868. No statistically significant difference was noted between any of the imaging modalities. CONCLUSION: CCD, CMOS, PSP and film performed equally well in the detection of occlusal and proximal dental caries. CCD, CMOS and PSP-based digital images provided a level of diagnostic performance comparable to Kodak Insight film.